Bones, Joints & Muscles

Walking Disorders

Gait Disorders

What is ‘normal walking’?
A child's normal gait (walking) pattern is different to that of an adult. A toddler ’waddles’, with their legs apart and bent, taking short steps to the side rather than forwards. Their arms are held high for balance. A child’s gait gradually matures until around seven-years old when it closely resembles that of an adult.
Could there be something wrong with my child?
There are some childhood conditions that cause unusual gaits, but most walking patterns are age appropriate or will correct without any help. If you have any concerns about the way your child walks, contact a Paediatric Physiotherapist who understands the normal development of walking. Kidsphysio physiotherapists will be able to provide reassurance, home advice, treatment, monitoring or onward referral depending on the outcome of a full assessment.

Some Examples of Different Walking Patterns

Tiptoe Walking
Many toddlers walk on their tip-toes, this usually improves by the time they start school. If your child is able to stand and walk with feet flat, the toe-walking habit will probably disappear on its own. Your child may need help if they:
  • Have stiff ankles or feet
  • Rarely or never stand, or walk with feet flat
  • Walk awkwardly, stumble, or have a ‘waddling’ gait
  • Are struggling to keep up with their peer group with running and other motor skills
  • Are losing motor skills
  • Didn’t like tummy time or didn’t crawl as a baby
  • Are still walking on their toes at 3-years old
What can Physiotherapy do?
A specialist children’s physiotherapist will assess your child and determine the reason for the toe walking, and may provide exercises to help your child’s muscle strength or joint mobility to help them walk with heel contact.
Knock Knees (Genu Valgum)
Gait DisordersA child who stands with their knees touching but their ankles apart is said to have knock-knees. Knock-knees are a part of normal growth and development, usually becoming apparent when a child is two to three years old and resolving by 6-8 years old, maybe increasing in severity until about age four. Your child may need help if:
  • one leg is affected more than the other
  • There is an ankle gap of more than 8cm
  • they complains of hip pain
  • they are under 2-years or over 6-years old
What can physiotherapy do?
Physiotherapy will not change true knocked knees as they are caused by bone position. However, it can help children who have flat feet, are overweight or are weak around the hips:
  • Posture activities.
  • Strengthening or mobilising exercises.
  • Advice on sports and activities.
  • Advice on orthotics and footwear.
  • Easing symptoms at the hip, knee and ankle.
If your child stands with their ankles together and their knees are apart, they have bow legs. Bow legs are normal in babies but should resolve by about 2-years. If bow legs persist after 2-years old, we recommend you seek advice from your GP.
Intoeing (Pigeon Toes)
In-toeing is common, affecting 40% of children. The turning in of the legs or feet may be due to the way the bones are formed or the way the hip or leg muscles work and usually corrects without treatment. Your child may need help if:
  • the intoeing is causing stumbling or tripping
  • one leg is affected more severely than the other
  • they are struggling to keep up with their peer group with running or activities
  • You notice any heat, redness or swelling in your child’s leg joints
  • They complain of pain, especially in the hip
  • Intoeing persists after 8 years of age
Can Physiotherapy help?
Depending of the cause of the intoeing, physiotherapy may be able to help with:
  • Exercises to strengthen either hip, knee or ankle (or all three)
  • Exercises to stretch tight muscles
  • Exercises and activities to improve your child’s core muscle strength
  • Postural advice – e.g. discouraging and finding comfortable alternatives to “w” sitting
  • Walking games and activities
  • Advice on footwear
  • Monitoring and onward referral if indicated
Out-toeing is when a child walks with their feet turned outwards. If you child’s feet turn out a lot they should see their GP.