Toddler Walking With Feet Turned In: Is It Normal?

What a new walker normally looks like

The NHS sets the baseline: "when children first start walking, it's normal for them to walk with their feet apart and their arms stretched out to help them balance", and "it's also common for young children to appear bow-legged or knock-kneed, or walk with their toes turned in or out." Its overall verdict is that "most minor foot problems in children correct themselves."

Legs also change shape in a predictable sequence. The American Academy of Pediatrics describes it: many children have bowing of the legs until about two years old, then look knock-kneed until about six, and some do not have straight lower legs until they are nine or ten.

In-toeing

Also called pigeon toes. The NHS says this "usually corrects itself around the age of 8 and treatment is not usually needed."

The AAP explains that the cause changes with age. In infancy it is often the front of the foot curving inwards, from the position the baby was in before birth, which usually resolves before the first birthday. In the second year it is most often an inward twist of the shinbone. Between three and ten it is usually an inward turn of the thighbone. Both of the latter tend to run in families and both usually correct themselves over time.

The AAP is emphatic about what not to do: "it is very important to avoid nonprescribed treatments such as corrective shoes, twister cables, daytime bracing, exercises, shoe inserts, or back manipulations. These do not resolve the problem and may be harmful because they interfere with normal play or walking." It adds that a night brace with connecting bars, once common, "hasn't proven to be an effective treatment."

Out-toeing

Feet pointing outwards. The NHS says this "usually corrects itself around the age of 4 and treatment is not needed in most cases." It is often more noticeable in children who were late to walk, and typically settles as they gain strength and their hips rotate inwards with growth.

Bow legs and knock knees

The HSE gives the clearest description. A child has bow legs if their knees stay apart when they stand with feet and ankles together. Knock knees means that when they stand with knees together, their feet and ankles stay apart — and it notes that a small gap between the ankles is normal.

Its timings: bow legs usually disappear without treatment by the time a child is 2 or 3, and knock knees are common in healthy children between 3 and 5, straightening as they grow. The NHS says knock knees usually correct themselves by the age of 7, and that before 18 months a small gap between knees and ankles when standing is very common.

The HSE is direct about treatments to avoid: do not try to straighten bow legs or knock knees with special shoes, leg braces, exercises or night splints, and do not put a child's shoes on the opposite feet. The AAP agrees that bracing, corrective shoes and exercise "are rarely helpful, and may hinder a child's physical development and cause unnecessary emotional stress."

Flat feet

The NHS is reassuring: "if your child appears to have flat feet, do not worry. If an arch forms when your child stands on tiptoe, no treatment will normally be needed. Flat feet usually correct themselves by the age of 6."

The AAP explains why babies look flat-footed: children's bones and joints are flexible, so their feet flatten when they stand, and young babies also have a fat pad on the inner border of the foot that hides the arch. It notes that flat feet normally disappear by about age 6, and that only around 1 or 2 in 10 children will continue to have flat feet into adulthood.

Its position on shoe inserts is worth quoting: "shoe inserts won't help your child develop an arch, and may cause more problems than the flat feet themselves." Treatment is not recommended for a child who does not develop an arch unless the foot is stiff or painful.

When to speak to a GP or health visitor

The NHS's general instruction is to talk to a GP or health visitor if you are concerned about any of these. The HSE gives a more specific list for legs. Go to a GP if your child:

• has difficulty walking;
• has pain or a limp;
• still has bow legs after age 3;
• has knock knees that worsen after age 8;
• is affected in only 1 leg;
• is small in height for their age.

The AAP's parallel list of signs that a leg shape may have a cause needing treatment is: the curvature is extreme; only one side is affected; bow legs get worse after age two; knock knees persist after age seven; or the child is unusually short for their age. It names arthritis, injury to the growth plate around the knee, infection, tumour, Blount's disease and rickets as rare causes.

For feet, the AAP says a paediatrician should check foot pain, sores or pressure areas on the inner side of the foot, a stiff foot, limited side-to-side foot motion, or limited up-and-down ankle movement. A rigid rather than flexible flat foot can be caused by bones that are joined together, and should be assessed.

The HSE adds a genuinely useful practical tip: take a photograph of your child every 6 months, with their knees facing forward, so a GP can see the trend rather than a single moment.

Shoes and toenails

Shoes will not change leg shape, but bad ones cause their own problems. The NHS says children's feet grow very fast under the age of 5 and it is important that the bones grow straight, that a child does not need proper shoes until they are walking on their own, and that shoes with laces, a buckle or Velcro are good because they hold the heel in place. A test it gives: "if the heel of a shoe slips off when your child stands on tiptoe, it's too big." Natural materials allow air to circulate; plastic shoes make feet sweaty and can cause fungal infections.

On nails, the NHS says to dry well between the toes after washing and to cut toenails straight across, otherwise a child may get an ingrown toenail.

One related note: the NHS says it is common for children aged 3 and under to walk on their toes, and to talk to a GP or health visitor if you have any concerns. If tiptoeing is constant, or your child cannot put their heels down flat, that is worth raising rather than watching.