During the early years there can be some obvious gait abnormalities in children. Most of these variances are quite common and correct themselves on their own.
In-toeing is common in young children, there are three main causes;
Femoral anteversion: this is where the femur (thigh bone) turns inwards causing the whole leg to turn in and is the most common cause of in-toeing. It is most evident between the ages of 2-4 and will usually resolve spontaneously by the age of 10.
Tibial Torsion: this occurs when the shin bone is twisted causing the foot to turn in even though the kneecaps point forwards. The stimulus of walking causes the tibia to rotate into more normal alignment. This will normally correct by age 4-5 as the bones grow, the walking pattern matures and the knees straighten. Splints or special shoes are not necessary.
Metatarsus Adductus: this is when the foot curves in and often results from cramped space in the womb and is evident from birth. Most will resolve spontaneously but in severe cases when the foot is stiff, stretches or advice on footwear may be necessary. Children who in-toe may tend to trip a little more at first but they will be just as mobile as other children and are no more likely to develop other problems. Young children often W-sit on the floor (where they sit with their bottom on the floor between their feet), this should be discouraged as it re-enforces the in-toeing and knock knee pattern.
Out-toeing is when a child’s feet point outwards. As with in toeing, this condition will usually resolve itself spontaneously with the maturation of gait.
It is normal for babies and toddlers to have “flat feet” due to the presence of fatty tissue on the insoles of their feet and lax ligaments. The arch flattens when they are standing and their feet tend to roll in and point outwards. The arch does not begin to develop until the age of 3 and may not develop until approximately 6 years of age. Many children present with “flexible flat feet” early in their walking development and may well grow out of out as their walking matures and they develop a longitudinal arch.
Walking in bare feet is ideal for promoting foot development. Flat feet usually resolve during normal growth and development. Most flat feet are flexible and most children have no symptoms. If your child complains of pain a referral to the podiatrist may be appropriate. Information on these can be found on the NHS Choices website www.nhs.uk in the pregnancy and baby section under leg and foot problems in children or in the attached leaflet.