There are many common pediatric gait abnormalities. Some of these abnormalities can resolve as a child ages, but there are some that may not improve over time or may worsen. If you notice your child has developmental delays or is having trouble with balance or walking independently, it may be due to a gait abnormality, and you should have them evaluated by a pediatric podiatrist.
Common Pediatric Gait Abnormalities
Young children who are learning to walk may show abnormalities such as having flat feet, bow legs, knock knees, or their feet may not point straight forward but bend inward or outward. These issues are common and generally resolve as the child ages. However, there are other gait abnormalities in children that may need the help of a podiatrist. Some of the most common are:
- Antalgic gait. Antalgic gait occurs when foot or leg pain changes the way the child walks or stands. They may develop a limp in their efforts to avoid the pain. This type of gait may occur as a result of a stubbed toe or a trip and fall and likely resolves on its own. However, antalgic gait is also seen in in children with juvenile arthritis, even if they do not have pain.
- Ataxic gait. Those with an ataxic gait may have instability when walking and have poor balance, veering, and difficulty walking a straight line. It can cause a child to alternate steps with a narrow to wide base and may cause them to stumble. This type of gait is seen in children with damage to the brain's cerebellum that controls muscle coordination.
- Circumduction gait. Circumduction gait can occur in children who have a discrepancy in the length of their legs or stiff or restricted joint movement. This type of gait causes the child to take steps without flexing the knee, making the movement stiff and rotated away from the body. It can be seen in children with conditions such as juvenile idiopathic arthritis.
- ‘Clumsy’ gait. Children with clumsy gait often have difficulties with their fine and gross motor skills. They may fall frequently or have trouble doing tasks such as dressing or eating on their own. In addition, those with clumsy gait may have poor handwriting or a learning disability.
- Spastic gait. Children with a spastic gait drag their feet and toes when walking. With spastic gait, a child may also hold their legs closer together and walk stiffly. Children with an upper motor neurological disease or those who have had a stroke can develop a spastic gait.
- Stepping gait. Children with a stepping gait lift their entire leg when walking in order to clear the ground. It is often seen in children with spina bifida or polio. It can also be seen in those with peripheral neuropathies such as Charcot-Marie-Tooth disease which causes difficulties in walking.
- Toe-walking gait with absent heel contact. It may be normal for some children to use their tip toes when first learning to walk. If toe walking becomes persistent and the child does not make heel contact to the floor, it may indicate a problem. Walking on the toes can be due to an underlying neuromuscular problem such as cerebral palsy or can be caused by a leg length discrepancy or developmental dysplasia.
- Trendelenberg's gait. Children who appear to “waddle” when they walk may have Trendelenberg’s gait. They may also limp to maintain their balance. Their hips, knees, and feet rotate externally when taking steps due to weak glute or hip muscles. Children with hip arthritis, muscular disease, or certain neurological conditions may exhibit Trendelenberg’s gait.
Walking Gait Abnormality Signs and Symptoms
Walking gait abnormalities don’t always cause pain, so the child may never complain. However,
there are several signs to be aware of that can indicate a problem with a child’s gait, including:
- Falling or tripping frequently
- Sitting in a “W” position
- Being fatigued after walking or physical activity
- Wearing down shoes in certain areas
- Feet appearing flat or in a “C” shape
- Keeping up with others when running or playing is difficult
Treating Pediatric Gait Abnormalities
For most pediatric gait abnormalities, a podiatrist will monitor a child over the course of several years. Since many of these issues will resolve on their own, treatment is not always needed. To diagnose a gait abnormality, your child’s podiatrist will do a physical exam and may order diagnostic tests such as an X-ray, MRI, or a CT scan.
Some options used to treat gait problems in children are:
- Shoes. Specific types or styles of shoes can be worn to help hold a child’s feet in position while walking or standing.
- Custom orthotics. Orthotics are used inside shoes to help provide additional support. An orthotic can help put the foot in proper position inside the shoe to reduce certain gait abnormalities.
- Brace. A brace can be worn to keep a child’s legs and feet in proper position while walking.
- Stretching and exercise. There are a variety of stretches and exercises that can be done to improve coordination and help with balance. These can improve the child’s gait by strengthening the leg and feet muscles.
- Medication. If your child has pain or swelling, an anti-inflammatory medication may be used to help relieve the symptoms.
Surgery is not typically recommended unless conservative options and time do not resolve gait abnormalities. There are surgical procedures that can be done to help correct the alignment of the feet and legs or to lengthen the tendons that are causing a problem with gait.
If the gait abnormality is due to an injury or a developmental issue, that condition will need to be treated in order for the abnormality to resolve.
When to See a Podiatrist
If you notice that your child is having developmental delays and is experiencing the following problems with their gait, it may be time to see a podiatrist for an evaluation:
- Gait problems are worsening over time and not improving.
- Your child is having issues with balance, limping, falling, or tripping.
- Your child is experiencing pain in their ankles or feet.
To discuss concerns about your child’s gait abnormalities, contact Capital Podiatry for a consultation. To schedule an appointment, call our office, use our telemedicine website, or fill out our convenient online contact form.