Is it concerning when your toddler is a late walker?

Many parents are anxious once their child starts walking. They are worried about the walking pattern, frequent falls, any apparent deformities and sometimes the delay in walking. On an average, the child starts walking around his/her first birthday. This milestone can be achieved as early as 8 months to as late as 18 months. Bowlegs, in-toeing gait i.e., walking with feet towards each other and flat feet are the most common concerns that the parents have when they visit the clinic.

Bowlegs (genu varum): Bowlegs are physiological at birth. The knees almost become straight when the child is around 1.5 years. Physiological knock knees (genu varum) can be seen at around 4 years of age which slowly reaches the adult knee pattern, by the age of 7 years. Unilateral deformities, associated with other illnesses or deficiencies and not following the physiological pattern, needs evaluation.

Intoeing gait: Parents are often worried about the child’s walking pattern. Intoeing gait is the most common complaint. In most of these children, the deformity is at the hip level due to a persistent foetal position of the thigh bone (femoral anteversion). Sitting in a W-pattern, instead of cross-legged sitting is often observed in these children. Persistent femoral anteversion doesn’t require any active intervention and usually resolves on its own over a period of time.

Flatfeet (pes planus): Foetal fat makes the feet flat and may persist until the age of 3 years. Normal arches of feet are usually seen by 3 years of age. Researchers have shown that the flatfeet are common in children who constantly wear footwear as compared to children who walk barefoot. Generalised ligamentous laxity is another condition where the child can present with flat feet. Many children are prescribed arch support in footwear for flat feet and in most of these cases, they are of no use. There is no scientific evidence to prove that these inserts create a normal arch.

Most of these conditions resolve with growth without any intervention. Parents need to understand that these are physiological patterns and no interventions are required.

Dr. Sarawati Vishwanathan
Consultant – Orthopaedics and Pain Management
Narayana Medical Centre, Langford Town


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