Problems with Walking Often Resolve with Age
Most parents have looked at their beloved child or toddler and had a thought zip across their minds.
Hey, wait a minute. Is my kid walking funny?
Maybe, says a pediatric orthopedist and associate professor of orthopedics and rehabilitation at University of Wisconsin School of Medicine and Public Health (SMPH). But the chances are good the issue will correct itself without medical intervention.
Most children experience some period of clumsiness as they master the art of walking and their bodies begin to grow. But if your child seems always to be stumbling over his or her feet, it may be a case of in-toeing, a common and normal condition in which the child's feet begin to point inward instead of pointing straight ahead. It's also known, of course, as pigeon-toe.
"In-toeing is the number-one thing we see in clinic other than fractures," says Blaise Nemeth, MD, who sees patients at American Family Children's Hospital in Madison. "It's the most common concern from parents that turns out to be nothing by adulthood."
Dr. Nemeth is a rarity-he's one of only a handful of "non-operative" pediatric orthopedic specialists in the country (he does not do surgeries). He runs a clinic focused on diagnosing and correcting gait issues in children who don't have cerebral palsy. He spends a fair amount of his time educating and reassuring parents who are concerned that their children's odd gait is a sign of future problems in adolescence and adulthood. And making sure there isn't real cause for concern.
By the time a child has reached the age of five or six, the most common cause of in-toeing - a twisted tibia - will have improved. Even children who are in-toed into their teens will still have what's considered a normal gait and function normally.
Ken Noonan, MD, a pediatric orthopedic surgeon and professor of medicine at UW SMPH, explains that it comes down to what he calls the "spectrum of normal."
"I often tell parents to think of it like hair color," explains Dr. Noonan. "You can have black, brown, blonde or red hair and it's all considered ‘normal.' By the same measure, other physical characteristics exist along a spectrum. Kids' feet turn in and turn out, but it's still normal."
There are a handful of reasons that could indicate a more serious neuromuscular issue, like mild cerebral palsy or spinal-cord abnormalities. If there are other development issues - for instance, if your child is having trouble keeping up with peers or is a late walker (older than 18 months) - that might require further evaluation.
These instances, says Dr. Noonan, are extremely rare. "Out of a thousand children who present to us with an unusual gait, maybe one ends up in the operating room and maybe three are referred to a neurologist."
Dr. Nemeth says that if your child's gait leads to a lack of interest in normal activities like running, jumping and playing, that should prompt attention from a specialist. Otherwise, parents should begin with their primary care physicians, most of whom are familiar with normal pediatric gait range.
Date Published: 04/01/2010