Children’s Gait

If you’re unfamiliar with the term, “gait” simply refers to the manner in which a person walks and the biomechanical processes he or she uses in doing so. This is important to know when we discuss children, and especially young ones who are first learning to walk.

There are many cases wherein a child’s gait pattern isn’t quite what you would expect to see. When this happens, it’s important to understand what is going on and what (if anything) should be done about it.

Intoeing and Out-toeing

Some children have a gait pattern that is affected by an issue known as intoeing. Also called “pigeon-toed,” this is a condition wherein feet point inwards. There are generally three different reasons why intoeing happens:

• Metatarsus adductus – the feet themselves have an unusual inward curve.
• Tibial torsion – an abnormal inward twisting of the shinbone (tibia) is responsible for the intoeing condition.
• Femoral anteversion – an abnormal inward twisting of the thighbone (femur) is responsible for the intoeing condition.

The good news about intoeing is the fact that a vast majority of cases resolve on their own over time.

Out-toeing, on the other hand, is less common, but can come with greater concern. There are definitely instances of this condition that will resolve themselves over time and do not present long-term issues. Often, these are when the outwards twisting happens to either the shin or thighbone. In even rarer cases, out-toeing happens due to a neurological problem.

In-toeing and out-toeing issues range in severity and may or may not cause problems for a child. If you are concerned with a son or daughter’s gait pattern, bring him or her in for an appointment and we can assess the situation. In the event treatment is needed, you can take comfort knowing that we have been able to help many children overcome difficulty in their lower limbs.

Pediatric Flatfoot

Sometimes gait abnormalities aren’t caused by the direction feet point, but instead by issues with arch height.

When you notice that your child has flat feet, it may raise a red flag in your mind and you can find yourself wondering: Is my child in pain? Will my child ever walk normally? Am I a failure for not catching it sooner?

(No, the flexible flatfoot is not causing your child pain.)

(Yes, in all likelihood, he or she will walk normally.)

(No, you are not a failure!)

Flexible flatfoot is a common condition where the foot arch disappears when a young child is standing or walking (or attempting to walk). When the child either sits or stands on tiptoe, the arch reappears. Typically, most children are born with this condition, even if it takes a little while to show. The vast majority will outgrow it without any long-term issues as the arches develop.

Treating flat feet before the age of 5 (and perhaps even a bit later than that) is often—but not always!—unnecessary, especially if the condition is not causing any discomfort or pain. If the condition is causing such issues, though, we will carefully evaluate the situation.

It is important to keep in mind that when no symptoms are experienced, there is no need for treatment. In such cases, we will simply want to monitor the condition and re-evaluate it periodically. When symptoms are present, however, there are various nonsurgical treatment methods that can be used, including:

• Modifying activities. Decreasing activities that cause pain, or switching them out for ones are low-impact, can help provide relief. In some cases, standing or walking for prolonged periods can cause difficulty and those should be limited as well.
• Prescribing orthotic devices. Our office can create custom orthotic devices that slide into your son or daughter’s shoes. This will support the structure of your child’s feet and lead to improved foot function.
• Physical therapy. In many young patients, prescribed stretching exercises will provide relief for flatfoot conditions.
• Shoe modifications. Certain shoes work better for individuals with low arches and we can help you find ones that might be best for your child.
• Medication. Ibuprofen and other nonsteroidal anti-inflammatory medications can reduce inflammation and pain. Our office will provide recommended dosage amounts, so be sure to call before giving any of these medications to your son or daughter.

Juvenile Bunions

It is possible for juvenile flatfoot to play a role in another medical issue – bunions. In this case, a bunion can begin to develop when flatfoot causes overpronation. The extra force on the inner edge of the foot (particularly at the base of the big toe) can lead to the first metatarsophalangeal joint—where a toe connects to the foot—becoming unstable. In time, the joint can be pushed out, which forces the big toe to angle inwards.

We typically treat cases of juvenile bunions with a conservative approach. The use of custom orthotics and medication is helpful in many instances. For some of our young patients, though, surgical intervention becomes a necessary consideration.

When Your Child Walks with a Limp

Sometimes, children develop a condition that causes limping. When this is the case, we can evaluate your child’s lower limbs and work to assess what is happening before we create a treatment plan to address it.

There are various reasons why your child might have developed a limp, including:

• Irritable hip – This is a fairly common condition that occurs due to lining in the hip joint becoming inflamed.
• Sever’s disease – This condition—the most common source of child heel pain—develops as a result of variance rates of physical development for a growth plate located in the back of your child’s heal and the Achilles tendon.
• Juvenile arthritis – Too often, people assume that arthritic conditions only affect the elderly. When experienced by younger patients, we refer to it as juvenile arthritis and it can cause swelling and pain in a child’s bones and joints.
• Transient synovitis – Illnesses that cause inflammation throughout the body may result in joints that have temporarily swollen and become painful.
• Severe viral infection – If a fever accompanies a limp and joint pain, the likely explanation is a viral infection.
• Tumors – In very rare instances, the culprit behind your child’s limping is a tumor that has growing into his or her bone and soft tissues.

Children’s Shoe Buying Tips

Shoes can sometimes affect—in both positive and negative ways—a child’s gait pattern. One of the best ways to make sure you provide your child with proper footwear is to know the best practices for buying his or her shoes. With that in mind, here are some tips to follow when buying children’s shoes:

• Have your child’s foot measured every time. As the base of the human body, feet develop quickly to support everything else. This means that your son or daughter’s feet have likely grown since their last pair. So enlist the help of an employee in the store or use the measuring device to determine your child’s current shoe size. Of course, be sure to keep the next tip in mind before you buy the shoes!
• A shoe size is only a guide. This is important to keep in mind because not all makes of shoes fit the same way. It is entirely possible to be a size-7 for one brand and a size-8 in another. So instead of relying on the number printed on the inside of the tongue, have your child actually try on shoes before buying them.
• Go shopping later in the day. Feet actually widen during the course of the day, which means that it is best to head to the store later (when feet are at their widest) for optimal comfort.
• Your child’s toes should be able to wiggle freely. If they can’t, the shoes are too tight and he or she needs a different pair.
• There should be room in the front. A shoe that fits well will have about a thumb’s width of space between the longest toe (not always the first toe!) and the front of the shoe.

Child Foot Care at Ripepi Foot & Ankle Clinics

If you notice your child has an abnormal gait pattern and you’re concerned about it, contact us at the earliest opportunity. In the event the problem needs treatment, earlier intervention is best. If you have any questions regarding child foot care or development—or you would like to request an appointment with either of our offices—don’t hesitate to call us at (440) 843-3692.