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Feet Abnormalities

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What are gait abnormalities? 

In the first few years of life, a child's normal gait, or walking cycle doesn't resemble that of an adult. A normal 1-year old, for example, has a wide-based stance and rapid cadence and takes short steps. In fact, it's not until a child is around 3-years old that clear adult gait patterns are detectable in a child. However, during the early years, there can be some obvious gait abnormalities-any number of disturbances in what is considered the normal walking cycle for that age group-that may become a concern. While many of these disturbances are quite common and correct themselves on their own, some require medical assistance. The most common types of gait abnormalities, discussed further below, are in-toeing, out-toeing, limping and toe walking. 

How are gait abnormalities diagnosed?

The diagnosis of a gait abnormality is made during a physical examination by your child's physician. The doctor will carefully observe your child as he or she walks or runs. During the examination, the physician obtains a complete parental and birth history of the child and asks if other family members are known to have any gait abnormalities. Depending on the type of gait abnormality and its suspected cause, other diagnostic procedures may include:

X-ray a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs into film. 

  • Computered tomography (also called CT or CAT scan) - diagnostic imagining procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. ACT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. 
  • Magnetic resonance (MR) imaging (also called MRI) a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer detailed images of organs and structures within the body. 
What are the most common type of gait abnormalities and how are they treated? 

In-toeing and Out-toeing

In-toeing means that the feet point inward instead of pointing straight ahead when walking or running. Out-toeing means that the feet curve outward instead of pointing straight. These are the most common gait disturbances that cause parents to seek advice from their child's doctor. If your young child has either of these walking patterns, quality orthopedic shoes are recommended. Your child might also need stretching exercises or special casts, braces or surgery, in most cases. Infants and toddlers with in-toeing and out-toeing are required to wear high supportive, orthopedic leather shoes or slippers. Properly fitted shoes with good arch support will correct the condition and line up little feet in place over time. Severe in-toeing or out-toeing may cause your child to stumble or trip. Other facts you should know include:
  • In-toeing and Out-toeing usually do not cause child pain
  • In-toeing and Out-toeing usually do not interfere with the way your child learns to walk

Neither problem has been linked to degenerative arthritis in adulthood

Common In-toeing and Out-toeing Condition

The following are the most common condition that can cause a child's foot or feet to curve inward or outward.

  • Tibial torsion is in-turning of your child's lower leg (tibia) either inward (internal tibial torsion) or outward (external tibial torsion). In the womb, the legs were in a confined position. Tibial torsion means they didn't rotate into the turned out position after birth.  The condition improves without treatment, usually before age 4. Splints, special shoes and exercise programs definitely help. High supportive, orthopedic shoes (properly fitted) would line-up the foot joints by making them stable so over time your child would begin walking straight. Consider surgery only if your child is at least 8-10 years old, and the problem has persisted, causing significant walking problems. Occasionally, a brace is used at night in children 18-30 months of age. For more information, see Tibial Torsion. 
  • Femoral torsion is the in-turning or out-turning of your child's upper leg bone(femur). It's most apparent when he or she is about 5-6 years old. Doctors don't know why femoral torsion happens. It is better without treatment.  Modified shoes, braces and exercise don't help. Consider surgery only if your child is older then 9 and has a very severe condition that causes a lot of tripping and an unsightly gait. In-toeing from femoral torsion becomes worse between 2 and 4 years of age. 
  • Bowlegs and knock-knees usually straighten out as your child grows. A wide range of knees alignment is normal in young children. Special shoes and wedges definitely help the condition and are highly recommended. High, orthopedic shoes with excellent support would line-up the foot joints and over time you will notice an immediate improvement. 

  • Flatfeet are normal in infants and young children. The arch develops in your child's foot until at least age 3. High supportive leather shoes are recommended with orthopedic innersoles to promote arch development. 
  • Metatarsus adducts is a common birth defect in which your child's feet bend inward from the middle to the toes. In severe cases, it may resemble clubfoot deformity. The condition improves by itself most of the time. That's why most newborns with it are not treated until they are at least several months old. Treatment usually involves special exercises, applying casts or special corrective shoes and has a high rate of success in babies aged 6-9 months.


If a child is suddenly limping, (walking with an unsteady gait, favoring one leg). It is most likely due to pain caused by a minor, easily treated injury. Limping can be caused by pain anywhere along the leg. Splinters, blisters, or tired muscles are common culprits, but sometimes limping can involve a more serious problem such a sprain, fracture, dislocation, joint infection, arthritis or, less commonly, a tumor. While evaluating your child, the doctor will try to distinguish between painful limping and non-painful limping. Non-painful chronic limping may be indicative of developmental problems, such as developmental dysplasia of the hip or neuromuscular problem, such as cerebral palsy. For more information on how these conditions are diagnosed and treated, see entries on these topics.

Toe-walking is one of the least common gait abnormalities. If your child walks on his or her toes, and it is under 1 years old, the problem can be normal, but after age 1, if the problem persists, it requires careful evaluation by your child's physician. Most cases of persistent toe-walking are familial or are simply secondary to tight muscles. Treatment may involve observation casting and physical therapy. Also, quality, leather orthopedic high tops are required to stabilize the muscles and stabilize the heel. Over time the toe-walking would definitely stop and your child will walk normal. Toe-walking may indicate a neuromuscular disorder such as cerebral palsy or it could denote developmental dysplasia of the hip or leg length discrepancy (if it involves one foot only). For more information on how these conditions are diagnosed and treated, see entries for these topics.

The following info has been published by Children's Hospital Boston in the primary pediatric teaching hospital of Harvard Medical School @2010




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