As a childcare provider, you are likely to observe many differences in children’s walking styles. Walking is a complex developmental task that varies in how it progresses from child to child.
There are several fairly common walking abnormalities in early childhood. You are probably familiar with some of them, like “knock-knees” and “pigeon-toes.”
As you observe variation in walking development and style among the children in your care, you may wonder if these differences are a cause for concern or part of normal development. You also may work with parents who are anxious about the progression of their child’s walking style.
Differences in Walking Styles
As a childcare provider, it is helpful to be aware of some of the most common gait abnormalities of early childhood. Survey a room full of active young children, and notice the differences in gait.
You may see children whose knees are closer together than normal (commonly known as “knock-knees”), whose feet point inward (“pigeon toes” or “intoeing”), or whose legs are bowed (“bowlegs”). You also may observe children who walk on their tiptoes or appear to be flatfooted.
Each child’s pediatrician or healthcare provider can provide guidance as to whether a young child’s walking abnormalities are simply part of that child’s development or early signs of a problem. The physician may use a physical examination, X-rays, a CT or CAT scan, or MRI for diagnosis.
Some abnormalities are more common in a specific age group. For example, tiptoe walking is most common in toddlers, while knock-knees tend to appear around age 2. Many of the walking styles of early childhood are directly related to a baby’s position in the womb; but others may be caused by orthopedic, metabolic, or nutritional problems.
Bowlegs occur in almost all children and are considered a normal part of development in the early years of life. A child who has bowlegs will have ankles that touch, but knees that do not touch while standing straight with the toes pointed forward. In most cases, bowlegs gradually disappear as the child begins walking. By age 4-5, most children’s legs have straightened.
Knock-knees occur when the knees appear to bend inward toward each other. In some cases, the condition is so pronounced that the child’s knees touch when he or she walks. Knock-knees are most common in children who are 2-4 years old.
In many cases, the condition will naturally correct itself as the child ages. Between the ages of 5-7, most children’s legs have straightened on their own. Knock-knees can look painful, but most cases are not.
Pigeon Toes (Intoeing)
Pigeon toes, or intoeing, occur when a child’s feet point slightly inward rather than straight ahead. It occurs in about two of every 1,000 children.
Like bowlegs, intoeing usually corrects itself. In children whose intoeing is a result of twisted shinbones or thighbones, the condition usually disappears between the ages of 6-8. Intoeing that is the result of curved foot bones typically corrects itself in the infant or toddler years.
Children who have intoeing may be more prone to tripping as they learn to walk. Some healthcare providers may recommend daily exercises for children who have intoeing.
Usually, the childcare program can integrate these exercises into the children’s daily gross motor activities if the family requests it. In the past, corrective shoes were often prescribed for children with intoeing but use has decreased with the realization that most intoeing corrects itself naturally.
Flat feet occur when the feet do not have a normal arch. In the standing position, the entire foot is against the ground. Children younger than 3 years old have naturally flat feet, as the arch does not begin to develop until around the third birthday.
Many infants and toddlers have a pad of fat in the arch area of their foot that makes it look very flat. This is normal and not a cause for concern.
After about age 3, most children have flexible flat feet, meaning the arch is flat in a standing position but returns when the child raises his big toe or stands on his tiptoes. Children with flexible flat feet also may have intoeing.
Flexible flat feet are painless and do not require treatment. Rigid flat feet, which are more common in older children, are typically painful and are often treated with shoe modifications, exercises, or surgery.
Tiptoe walking is common in toddlers until about the age of two. It typically is the result of a short Achilles tendon, which makes it difficult to put the heel down. As the child begins to walk, the tendons will begin to stretch and tiptoe walking may disappear.
Some children ages 2-5 continue to tiptoe out of habit, particularly when they are distracted. If the child’s healthcare provider determines this is the case, the child may benefit from gentle, consistent reminders to put the heel down before the toes.
As children who are habitual tiptoe walkers develop more complex skills like running, jumping, and climbing, which require the heel flat on the floor, they often begin to tiptoe less frequently. Encouraging these gross motor skills is beneficial for many children.
In rare cases, tiptoe walking can be a sign of a serious condition, such as cerebral palsy, Duchenne muscular dystrophy, or autism. But in most of those cases, tiptoe walking is but one of the symptoms of the condition that are present.
Be alert to symptoms associated with walking that may indicate a problem, including pain, limping, swollen or discolored legs or feet, and conditions that are asymmetrical and affect only one leg or foot, such as dragging one leg. Some children whose feet or legs are not aligned properly may complain of fatigue because they “favor” one leg or foot over the other.
Unequal shoe wear (one shoe becoming more worn than the other) can be an indication that a child is using one leg or foot to compensate for the other. Young children often trip and fall because they are inexperienced walkers. But constant tripping and falling could be a warning sign of a more serious problem.
Encourage families to allow children to go barefoot as much as possible for healthy foot, ankle, knee, and hip development. Finally, keep in mind that walking is a fairly difficult, complex task of early childhood. Remember to encourage and reassure children as they learn to walk, run, and move in their own unique and individual ways.
Parent Educator, Asheville City Schools, Asheville, NC
Bowleg and Knock Knees, www.childrensorthopaedics.com/BowlegandKnockKnees.html
Flat Feet, www.med.umich.edu/1libr/pa/pa_flatfeet_hhg.htm
My Child Has Gait Abnormalities, www.childrenshospital.org/az/Site932/mainpageS932P0.html
Myths and Truths About Walking, www.parenting.com/Common/printArticle.jsp?articleID=21335237
Walk This Way,