Being a Paediatric Orthopaedic Surgeon, this is the commonest question, mothers have regarding their child’s walking pattern. There are various reasons for an altered walking pattern which could range from congenital (by birth), post-trauma or infection, developmental, metabolic, neuromuscular, or even idiopathic.
Let me take you through some common walking-related complaints and questions.
- “My child has not yet started walking?” It’s fairly normal for a kid to start standing and walking by age 12 months-15 months. Relax, let the child grow. It would be a concern certainly, if the child was born premature, or has a history of delayed milestones, convulsions or any incident of brain insult in early infancy. This would need further check-up and management accordingly.
- “My child walks on toes” Walking on toes could be normal till age 3 years, beyond that Idiopathic toe walking, a common condition where child tends to stand normal with flat feet, but while walking or running he will be on toes. Early therapy does help in this condition while other causes like Muscular Dystrophy, Cerebral Palsy, and neurological conditions need to be ruled out.
- “My child has bow legs” It is normal to have bow legs till age 2, it’s physiological. Bowing is a concern if it’s seen beyond age 2 and is progressing needs blood investigations to diagnose Rickets (Vitamin D deficiency disorder) which is the most common cause and rule out other conditions like Blount’s disease.
- ” My child has in-toeing” In-toeing could be due to inward angulation of the femur (thigh bone) or the tibia (Leg bone) during development, which also leads to W sitting. Usually, this normalizes by age 9. The presence of other deformities or foot problems should be ruled out.
- “My child is limping” Limping usually presents with some trauma, infection, inflammation across any of the bones or joints in the lower limbs, each of these conditions needs to be attended at priority.
- ”My child’s walking pattern is not normal” Often children with neuromuscular disorders related to the brain and spinal cord may have an abnormal walking pattern. These are complex gait (walking) patterns and need timely investigations and staged treatments to get a near-normal walking pattern. These are commonly seen in Cerebral Palsy, Spina Bifida, neuropathies, and Dystrophy.
- “Is there any test to identify walking problems? Understanding the complaints, evaluating the child followed by blood tests, x-rays, scans or MRI can give a lot of information about the cause of altered walking patterns. A more detailed, precise way to quantify walking would be a visual gait analysis or a 3D instrumented gait analysis for complex gait (walking) patterns.
Normally, the walking pattern sets in till age 3 years, and anything altered beyond this age should be a concern for parents. In my experience, the grandparents and mothers usually spot even the slightest changes in walking patterns. I have enumerated some common causes above, early intervention can certainly help the kid walk better.