The Complex Art of WALKING – Part 2

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Welcome to part 2.

There are lots of variations in walking which come with age, weight and growth. All of these need to be considered and often there are a lot of parental concerns with regards to this, so “what’s normal” and when do I come and see a professional (i.e. us!)?  This blog aims to answer some of these questions.

Flat feet

ALL CHILDREN have flat feet. Initially. No-one is born with arches in their feet, they are something you develop over time. Children have fat pads in the bottom of their feet which hides their developing arch. On top of this as babies have more joint laxity the prominence of flat feet is higher. However, that said there is a difference between a ‘flexible’ flat foot and a ‘fixed’ flat foot.

A ‘flexible’ arch is when your child’s foot appears flat in standing, but when they stand on tip-toes you can see an arch developing. Flexible flat feet DO NOT need treatment. Whereas a ‘fixed’ flat foot is when there is no arch development seen on tip-toe standing. Most children’s foot posture and walking  pattern doesn’t fully develop until they are around 7 years old, sometimes even later. That said, around 1 in 5 children never develop an arch, so, ‘what’s normal?’ and when should you be concerned and come in and see us?

The answer to that is simple:

  • If your child has pain
  • If their activity is limited
  • If only one foot is affected

In-toeing gait

Intoeing gait is one of the most common referral reasons for little ones to come and see us. You may also know it as “pigeon toe walking”, basically, when your child walks, their feet turn in. Sometimes it can be both feet that turn in, other times it may be just one but what is normal and when should you be concerned?

You may notice an increase in ‘intoeing’ when your child is tired or you may  notice an increase in the number of trips and falls from tripping over their feet…this is all really common and often more-so in children who are a little bit more flexible than their peers!

Why?

There are a few reasons why children might intoe when they walk (ignore the medical terms, they’re designed to make it sound more complicated than it is I’m sure!).

  • Femoral anteversion Your femur (aka the long bone in your thigh) turns in. This is most common in girls (although boys can still get it) aged 2-4 years old and often resolves spontaneously by the time your 10.
  • Tibial Torsion Your tibia (aka the larger of the two bones in your shin) turns inwards, despite their knees facing forwards.  Again this normally self corrects by the time a child reaches 5.
  • Metatarus adductus: Your matatarus bones (toe bones) curve in. This is often due to reduced space in the womb and will resolve spontaneously over time, however if you notice persistent intoeing your child may benefit from specialist advice and footwear.
  • Tight/ weak muscles: Tightness in the muscles in the back of your thigh can cause intoeing, additionally weakness around the hips can also cause your child to intoe. This may be more apparent when your child is tired at the end of school  or after a recent growth spurt.

If you’re concerned that your child may have tight or weak muscles, or are concerned that your child is walking with an intoeing gait that they didn’t previously have, please come in and see a specialist who can advise you on specific do’s and don’ts to help improve your child’s walking posture.

Some simple fun exercises to encourage your child away from an in-toeing walking pattern::

-Try out toeing activities such as
-ballet
-martial arts
-swimming and
-horse riding

-Practice walking like a penguin with your feet turning out

 

Out-toeing gait

Out-toeing gait is when your child’s foot points outward instead of straight ahead when they run or walk. It is much less common than in-toeing gait and there is often a family link to out-toeing. Out-toeing gait often will correct on its own;  however there are some conditions that cause out-toeing that are more serious so please come and see us if you’re worried or if:

  • Your child is complaining of pain in their hips or knees
  • If your child is walking with a limp
  • If your child finds it hard to fully bend or straighten their legs
  • If their activity is limited
  • If only one foot is affected

Tip-toe walking

There are different causes of tip-toe walking. In children younger than 3 who have no other medical complications then typically tip-toe walking will resolve spontaneously. Tip-toeing can be a habit (habitual tip-toe walker) however if it persists past the age of 3 with no other known medical reason it is known as idiopathic tip-toe walking. Tip-toe walking can also be seen in other medical conditions such as:

  • In children with Autism Spectrum Disorder (ASD).
  • In children with a Neurological disease
  • Children with Inflammatory problems
  • Children with Metabolic conditions
  • Children with Congenital abnormalities

If you are concerned about your child walking on their tiptoes then please come in and see us for a full developmental assessment.

When to come and see us?

  • If your child has pain in their feet or legs
  • If your child complains of early morning stiffness
  • If your child is finding it impacts on their function
  • If your child has regressed in their development
  • If your child has had a change in their mood/ behaviour
  • If your child is noticeably more clumsy
    Lucy Phillips (Specialist Paediatric Physiotherapist)
    Contact the Back & Body Clinic today on 01604 493066.