Normal Gait Of A 9 Year Old Boy

Normal Gait Of A 9 Year Old Boy

Normal gait variations in children

The following are considered normal variations of gait in children, and parents will often consult for advice:

• Toe walking is common up to 3 years.
• In-toeing can be due to persisting femoral anteversion. Children walk with knees and feet pointing inwards (this is most common between ages 3-8 years).
• Internal tibial torsion is also common (knees point forwards but feet point in).
• Metatarsus adductus is a flexible 'C-shaped' lateral border of the foot. Most resolve by the age of 6 years.
• Bow legs (genu varus) are common from birth to early toddler-hood, maximum at age 1 year, often with out-toeing. Most resolve by 18 months.
• Knock knees (genu valgus) are common and associated with in-toeing. Most resolve by the age of 7 years.
• Flat feet are common. Most children have a flexible foot with a normal arch on tiptoeing. Flat feet usually resolve by the age of 6 years.
• Crooked toes. Most resolve with weight-bearing.

If these normal variations persist beyond the expected age range, are progressive or asymmetric, or if there is pain and functional limitation (or evidence of neurological disease) then referral is needed.

Remember to consider hypophosphataemic rickets in children with bow legs or knock knees, particularly if the child is also short (less than 25th centile for age).

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