Baby Steps --Learning to Walk
Of all the milestones a baby reaches – her first smile, her first game of peek-a-boo, her first words – there is nothing more exciting than her first steps.
Children begin to walk anywhere between 8 and 18 months of age. Once they begin to stand on their own two feet, parents might notice some abnormalities in their child’s stance or walk. Many of these perceived irregularities are normal and will correct themselves in time. Others could require the evaluation of a pediatrician or specialist.
Differences in baby feet
Most problems with feet aren’t really problems at all. For example, most toddlers are flat-footed when they first start walking, or tend to walk “pigeon-toed,” or with their feet turned inward, due to undeveloped muscle tone and weak ligaments. These tendencies will improve as the feet strengthen. True problems will show up in the late toddler/early childhood years.
If your baby’s feet still appear to be flat by the time he is 2 1/2 to 3 years old, he may truly be flat-footed due to a bone deformity or a tight Achilles tendon. The condition can lead to leg cramps, bunions and other problems as early as the teenage years. He should be evaluated by a physician, as flat feet can be easily treated with shoe inserts. In some severe cases, surgery may be recommended.
Walking differences
Another concern of parents is “toe walking.” Most babies begin their walking career on their toe, and it is normal for novices. However if the child continues to do so after a few months, she should be seen by a pediatrician to rule out problems.
Other problems involving the feet include:
- Intoeing, or “pigeon toes,” occurs when one or both feet point inward. This can be caused by an abnormal rotation in the foot, leg, thigh or hip. Some children outgrow the condition; some do not. A pediatrician can assess whether the child needs further treatment.
- Out-toeing. Occasionally, toddlers walk with their feet turned outwards. In most cases, out-toeing resolves by itself as the child establishes posture and balance.
Leg differences
Other problems a parent might notice in their new cruiser is differences in the legs. Toddlers sometimes appear to be knock-kneed (turned in at the knees) or bowlegged (turned out at the knees). Under normal circumstances, his legs will straighten out in time. If you are concerned, your pediatrician can evaluate your child’s knees to determine if they are in proper position for his age.
An abnormality that can cause definite problems is leg length discrepancy – having one leg longer than the other. The greater the discrepancy, the more a child must compensate his normal posture and gait, which can lead to a variety of symptoms, such as functional scoliosis, hip, knee and ankle problems.
There are generally two kinds of leg length discrepancies: structural discrepancy occurs when either the thigh or shin bone in one leg is actually shorter than the corresponding bone in the other leg; functional discrepancy occurs when the leg lengths are equal, but symmetry is altered somewhere above the leg, such as in the hip.
The following are symptoms of a leg length discrepancy:
- One leg is obviously shorter than the other
- Problems with posture (one shoulder may tilt toward the shorter side)
- Gait problems, such as limping, toe-walking, or rotation of the leg.
- Pain in the back hip, knee and/or ankle
Treatment for leg length discrepancy includes:
- Orthotics. A shoe lift can be used to treat small discrepancies.
- Prosthetics. These can be used for those with large discrepancies who would not benefit from lengthening or shortening procedures.
- Surgical treatments, such as shortening and lengthening procedures.
Date: June 2009
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