My Toddler Walks Funny: Should I Be Worried?

Toddler walking looks odd because toddler walking is odd. Wide steps, turned-in feet, bowed legs, flat feet, arms held high and a general air of controlled falling are all part of the first couple of years on two legs. The overwhelming majority of these patterns correct themselves with growth and need no treatment at all.

The common patterns and their usual timelines

• Bow legs. Normal in babies and young toddlers. Most straighten by around two to three years, often passing through a knock-kneed phase afterwards.
• Knock knees. Common between about three and five years, and legs are usually in a typical adult alignment by around seven or eight.
• In-toeing, sometimes called pigeon toe. Caused by the shape of the foot, a twist in the shin bone, or a twist at the thigh bone. It usually improves gradually over several years, often by around age eight, without braces, special shoes or exercises.
• Out-toeing. Usually resolves by around age four and rarely needs treatment.
• Flat feet. Normal in toddlers. The arch typically develops over the first several years.
• Toe walking. Common in new walkers; worth assessing if it persists past age two.

Why we usually watch rather than treat

For typical presentations, special boots, braces, insoles and corrective exercises have not been shown to speed up what growth does on its own. A simple, useful habit is to photograph your child standing, from the front and the side, every six months. That gives you and your doctor an objective record of whether things are improving.

Signs that deserve an assessment

• The pattern affects one side only, or the two legs look clearly different from each other.
• It is getting worse rather than better, or persisting well past the usual ages above.
• There is pain, a limp, joint swelling or restricted joint movement.
• Your child is tripping or falling far more than peers, or struggling to keep up.
• Your child is very short for their age or growth is a concern.
• There are other developmental concerns, or the gait pattern is stiff, scissoring or asymmetric.
• Your child walks on tiptoes most of the time after age two.

What an assessment involves

We watch your child walk and run, barefoot, from several angles. We check hip, knee, ankle and foot movement, leg rotation, muscle strength and tone, leg lengths and joint flexibility. Most appointments end with reassurance and a timeline. Where something does need attention, we explain what, why and what happens next, and involve your GP or a paediatric orthopaedic service as required.

When should I seek prompt medical advice?

Seek prompt medical assessment for a sudden change in walking, refusal to bear weight, a limp with fever, a hot or swollen joint, severe pain, new weakness, or loss of walking skills.

A reassuring takeaway

If your toddler's walking looks unusual but they are pain-free, symmetrical, keeping up and steadily improving, time is almost always the treatment. If any of those four things is missing, that is the moment to have it checked.

Sources and further reading

Royal Children's Hospital Melbourne --- Bow legs and knock knees fact sheet

Raising Children Network --- Gait: pigeon toe, out-toeing, toe walking

NHS --- Leg and foot problems in children

Suggested closing call to action

Still unsure about something you have noticed? A GP, child health nurse or paediatric physiotherapist can help you decide whether your child would benefit from an individual assessment. Contact PHYSITEK to ask about a paediatric physiotherapy visit.