Walking and how it develops

Gait is the way we walk.

Walking starts to develop as soon as children learn to stand up. It continues to develop as children’s muscles, bones and joints strengthen and mature, their gross motor skills and coordination improve through practice, and they gain confidence.

Children develop the skills for walking at various ages. But typically developing children usually gain these skills in the same order:

• By 7-13 months, some children might take their first steps with someone holding their hands.
• By 11-13 months, some children might be able to stand alone, sidestep around furniture, and take uneven steps between furniture.
• By 12-14 months, some children might stand and take unsteady steps, walk with ‘flat feet’ and walk with their legs wide apart. Children might also walk by pushing toy barrows, carts, trolleys and so on.
• By about 18 months, most children are walking well with their legs closer together. They can start and stop easily. They might also be starting to go up stairs or run.

It takes several years before children can walk in the same way that adults walk.

Some neurological conditions like cerebral palsy or muscular dystrophy might lead to delays in walking and to the development of gait disorders. Sometimes autistic children and children with intellectual disability or learning difficulties have walking delays and gait disorders.

If your child hasn’t learned to walk independently by the age of 18 months or if you have concerns about your child’s development, speak with your GP, child and family health nurse or paediatrician. They can help you work out whether something is affecting your child’s ability to walk.

About gait disorders in children

Children with gait disorders walk in ways that aren’t typical for children of that age.

Gait disorders might be obvious when children first start walking, particularly if the disorders are severe. Some children develop gait disorders at a later age, and sometimes gait disorders get worse over time.

But most gait disorders in children improve by themselves with time.

There are a few common gait disorders in children:

• pigeon toe or in-toeing
• out-toeing
• toe walking.

Pigeon toe or in-toeing

This is when one or both feet turn in while children are walking. Sometimes children’s knees also turn in.

Pigeon toe is common in children. It often appears at 2-3 years of age. It generally improves gradually as children develop strength and control.

Pigeon toe can be caused by foot problems like metatarsus adductus or clubfoot. It can also be caused by problems with the alignment of the shin or thigh bones.

Children with pigeon toe might trip or fall a lot. They might also have an unusual running style with their feet swinging out as they run.

Pigeon toe is generally painless, unless it’s severe.

Out-toeing

Out-toeing is when one or both feet turn out while children are walking. Out-toeing can develop as children grow, and it often appears by about 5 years of age. Sometimes it happens suddenly in late childhood or adolescence.

Out-toeing can be caused by foot problems like flat feet or problems with the alignment of the shin or thigh bone. Sudden out-toeing in late childhood or adolescence might be caused by a hip joint problem.

Out-toeing is generally painless, unless it’s severe.

Out-toeing is less common than pigeon toe.

Toe walking

Sometimes children start walking on their toes as soon as they start to walk. Toe walking is common in children up to 2-3 years of age. It usually improves by itself with time.

If toe walking doesn’t improve, over time it can make leg muscles tighter or shorter. This might lead to balance problems and muscles that get sore after a lot of walking.

Bow legs and knock knees are common conditions in young children. Although they aren’t gait disorders, they can affect the way children walk if they’re severe enough.

Medical help: when to get it for children with pigeon toe, out-toing or toe walking

You should take your child to your GP if your child:

• is 18 months or older and not walking independently yet
• trips or falls a lot
• can’t or won’t put weight on a leg
• complains of hip or knee pain, particularly while running or playing sports
• says that hip or knee pain is stopping them from running or playing sports
• has walking issues that come on suddenly or after a fall.

See your GP if your child’s pigeon toe or out-toeing:

• is severe
• is worse on one leg compared with the other leg
• is getting worse
• first develops in late childhood or adolescence.

See your GP if your child’s toe walking:

• hasn’t gone away by the age of about 3 years
• happens every time they walk
• is on one leg but not the other.

You should also take your child to the GP if you have any concerns about your child’s ability to walk.

Diagnosing gait disorders

Your GP will look at how your child walks and might do a physical examination of your child’s joints and muscles.

The GP might refer your child to a physiotherapist, an orthopaedic surgeon or a podiatrist for further tests.

Sometimes these health professionals will ask for an X-ray, MRI or CT scan so they can see whether there are any structural problems with your child’s feet or legs that might be causing walking problems.

Treatment for gait disorders

Treatment for gait disorders depends on the cause and severity of the disorder, as well as your child’s age.

Most gait disorders are mild and don’t need treatment. They’ll sort themselves out as your child grows. In these cases, your health professional will keep checking your child’s development to make sure the problem is going away.

In other cases, children might be given:

• gentle strengthening exercises
• orthotics to wear in their shoes
• a series of lower leg casts to stretch the leg muscles.

Some children with more severe and persistent gait disorders might need orthopaedic surgery.

If your child is autistic or their gait disorder is caused by an underlying neurological condition, your child’s specialist will manage your child’s condition.

Early identification of gait disorders is important. It means that your health professional can monitor your child’s development over time and recommend treatment if needed.

Preventing gait disorders

There’s no way to prevent your child developing a gait disorder.

When young children first learn to walk, bare feet are best when it’s safe. Wearing shoes can actually make early walking harder. And when it’s time for shoes, it’s best for your child to wear supportive and well-fitting shoes. Having your child’s shoes fitted by a child shoe specialist is a good idea.