As a Podiatrist with a special interest in children’s walking patterns, these are the four most common gait and leg alignment seen in practice.

In- toeing

In- toeing: when a child walks or runs, the feet or knees point inward instead of straight ahead, and is caused by differences in the inward rotation of bones in the thigh or lower leg.

Most children have no pain or symptoms, but the appearance may be concerning to parents. There may be an awkward appearance when the child walks or runs, and they may also sit differently, in a W-position with the knees in and feet out to the side.

Fortunately, most children grow out of this on their own. In- toeing from the lower leg usually resolves by age 4-5, whereas in- toeing from the hip/thigh takes a bit longer to resolve, by age 8-10.

Whether to worry depends on your child’s age. If your child is younger than age 10, most in- toeing will get better without any treatment.

Flat feet

Flexible flatfoot is a common condition seen in children. Both feet are affected, so this is commonly described as having “flat feet.”

In this condition, the arch of the foot flattens when the child stands, due to the flexibility of the foot joints. The arch reappears when the child stands on tiptoes or sits with the feet hanging down.

Parents often worry about flat feet, and whether treatments such as inserts or orthotics are needed. The good news is that most children outgrow this with time, and treatment is not necessary if the child does not have symptoms.

The foot arch forms by age 5-10 in most children with normal growth. For more than 80% of young children with flat feet, the condition will eventually resolve and a normal arch will develop by early adolescence.

Studies have shown that wearing inserts, orthotics or corrective shoes does not make it more likely for an arch to develop, or make arch development occur at a faster rate.

Whether to worry depends on the child’s symptoms. For a child with no symptoms, no treatment is needed. With time and growth, the arch will usually develop on its own.

However, flat feet can cause foot pain or discomfort in the medial arch, especially with long walks or strenuous physical activity. This usually responds to properly fitted and good-quality shoes, calf stretching at home or with a physical therapist, and arch support or orthotics.

If pain persists despite this, surgery can be considered, and occasionally is necessary for severe flat feet in older children or adolescents with refractory symptoms. Some flexible flat feet will become stiff and rigid over time, and this requires further evaluation to see if other problems are present (e.g. tarsal coalition).

Bowed legs

Bowed legs are common in infants and toddlers. When a child with bowed legs stands, the feet are together but a large space is noted between the knees. One or both legs may be affected.

Most cases of bowed legs in infants and toddlers will naturally straighten with time and growth. If bowed legs are not resolved by age 3, there may be an underlying pathologic cause, such as Blount’s disease or rickets. Adolescents may also present with bowed legs, usually in a child who is significantly overweight.

Whether to worry depends on your child’s age and the severity of the bowing. Mild bowing in an infant or toddler under age 3 is typically normal and will get better over time. However, bowed legs that are severe, worsening or persisting beyond age 3 should be referred to a specialist.

Knock knees

Knock knees are commonly seen in children. When the child stands, the knees touch and the ankles are far apart.

This may cause an awkward appearance to the child’s gait, with the knees hitting when the child walks and runs. Most mild cases have no symptoms. However, persistent or severe knock knees can cause knee pain or kneecap problems and may increase the risk of arthritis in older age.

Physiologic genu valgum refers to the normal pattern of knock knees that appear after age 2 in most children. This initially gets worse and is most notable at about 3-4 years of age, and then starts to get better with time, with most children reaching a normal alignment by age 8-10.


Consider seeing a Resonance Podiatrist if you are at all concerned about your child:

  • A strong family history of lower limb problems
  • Severe or getting worse over time
  • Painful: causing foot pain, trouble with shoe wear, or limiting participation in physical activities or significant gait problems.

(09) 212 9612

0800 473 776