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Many parents have looked at their beloved child or toddler and had a thought zip through their minds: "Hey, wait a minute. Is my child walking funny?"
Maybe, says Blaise Nemeth, MD, a UW Health Kids pediatric orthopedist. Most walking issues fall on a spectrum of normal, and the chances are good that the issue will correct itself without medical intervention.
One of the nation's few "non-operative" pediatric orthopedic specialists — he does not perform surgeries — Dr. Nemeth says parents of new toddlers frequently ask about three issues related to walking:
In-toeing (or "pigeon-toe" walking)
Toe walking (walking on just the toes, not the whole foot)
Late walking (not walking by 18 months of age)
Most children experience some period of clumsiness as they master the art of walking and their bodies begin to grow. But if your child seems to be stumbling over his or her feet, it might be a case of in-toeing.
In-toeing is a common and normal condition in which the child's feet begin to point inward instead of pointing straight ahead. It's also known as pigeon-toe and is typically a result of the child's tibia (lower leg bone) and/or femur (thigh bone) twisting slightly inward.
"In-toeing is the most common walking-related concern parents have about their kids," said Dr. Nemeth, who cares for children with a wide range of orthopedic issues. "Typically, parents who think their toddler is walking pigeon-toed will talk with their pediatrician or family physician. Thankfully, in-toeing usually improves considerably on its own by age 10 to 12 — often much sooner — so even if it does not go away completely, it seldom impacts a child's ability to keep up with peers or stay active."
Only in the most extreme cases would surgery be considered to correct in-toeing, according to Dr. Nemeth.
As toddlers learn to walk, it is not unusual to see some of them walk on their toes, especially during the second year of life.
"Similar to what we tell parents about in-toeing, toe walking tends to resolve by itself — usually by age 4 to 6, and in many cases, by age 3" said Dr. Nemeth. "Time typically takes care of this, so if the child is keeping up with peers and not developing tightness in the Achilles tendon (heel cord), there is usually no cause for worry"
Parents should be more concerned, said Dr. Nemeth, if they have a child who never walked on just their toes but then starts toe-walking later at age 3, 4 or 5.
"When kids start toe-walking a few years after learning to walk, parents should have it checked out," Dr. Nemeth said, "especially if the child also has delayed speech or does not start walking until 18 months or later."
Situations like this could be linked to other conditions, including neuromuscular issues (such as muscular dystrophy), sensory processing disorder or autistic spectrum disorder, Dr. Nemeth said.
Most kids begin walking between 11 and 16 months, although some don't start until 18 months.
"While we don't see too many children who walk late, kids who are not walking by 18 months should have blood work done to test for conditions such as hypothyroidism (an underactive thyroid gland), cerebral palsy or muscular disease," said Dr. Nemeth. "Other possible causes of late walking could include low muscle tone (when the muscles feel "floppy") or high muscle tone (very tense muscles). In any case, 18 months is a good time to check things out if your child isn't walking by then, Dr. Nemeth said.
Finally, remember that most walking issues with toddlers resolve on their own. If, however, your child's gait leads to a lack of interest in normal activities like running, jumping and playing, that should prompt attention from your primary care provider, who might refer you to a specialist in pediatric rehabilitation medicine, developmental pediatrics, pediatric neurology or pediatric orthopedics.