Walking delay and other foot and leg problems in babies
Most babies can stand
up and take their first steps between the ages of 8 and 18 months. Shortly
after their first birthday, they can usually take a few steps on their own, but
before that they are already beginning to “navigate”—walking along the edge of
a sofa or table, using furniture, or using their arms tensed to support each
other. But what if your child has signs of delayed walking? And if you notice
that your child is bow-legged or walks on tiptoe, should you be worried?
There are big
differences in learning to walk from child to child. The timing of first steps
can also vary among children of different ethnic backgrounds. A child can only
walk three to four months after another child has started walking. This does
not necessarily signal a problem or delay in walking. Both children are likely
to be equally healthy and able to run and play as they get older.
Are baby's bowed legs a concern?
Bowlegs are often a
concern for new parents, who may not realize that almost all babies are born
with bowlegs. This external curvature of the bones of the lower leg usually
resolves by 2 years of age. Toddlers usually sway from side to side rather than
forward at first, which makes their crooked legs even more exaggerated. Crooked
legs do not delay walking and do not affect the child's ability to learn to
walk.
In some rare cases
where leg curvature does not resolve naturally by age 2, your child's knees may
be twisted outwards due to the curvature of the leg bones. This can cause knee
problems. If bowed legs appears suddenly or persists after 2 years, contact
your child's doctor.
In rare cases, bowed legs
are a sign of rickets. This is a condition caused, among other things, by a
lack of vitamin D and calcium in your child's diet, which hinders bone growth. Bowed
legs can also be caused by a relatively rare condition called Blount's disease,
which causes abnormal bone growth in the tibia or lower leg.
Are pigeon toes a problem for babies?
Many babies have a
small dimple at birth, also called a pigeon toes. This usually takes place
during preschool years.
Pigeon toes can be
caused by problems with any of the three areas of the lower leg and foot. There
may be a deviation of the foot, called metatarsal adduction. There may be
problems with the head of the femur on the thigh. Finally, it may be due to
problems with the tibia or lower leg bone - internal torsion of the tibia.
The adductor
metatarsus seen in infants tends to disappear by the time the child begins to
walk. This is a curvature of the foot itself, usually created by the position
of the baby in the womb before birth, although other factors are possible. You
can see metatarsal adduction if you look at the soles of your child's feet.
They will curve towards each other like two crescents.
Doctors disagree
about whether or not orthopedic insoles should be worn for a child with severe
clubfoot. Some doctors advise wearing a corset or a cast if the feet are still
severely deformed in a child between 4 and 6 months of age. The splint or cast
is usually removed when the child begins to walk. Other doctors don't think
that the corset helps align the toes or speeds up the development of the feet
and legs towards more proper alignment.
If your child's knees
point forward on entry, they may have medial tibial torsion, which is most
common between the ages of one and three. This condition is caused by internal
rotation of the tibia (lower leg). This usually goes away when the child learns
to walk. If not, see your doctor for possible treatment.
If your child's knees
tilt inward on entry, they may have a condition called excessive hip
anteversion. This condition is caused by internal rotation of the femur (upper
leg bone) and is often seen in children sitting with their lower legs behind
them in a W shape. Again, it usually resolves on its own - usually around age
8. years.Usually on their own - usually at age 8 or so.
All of these
conditions usually go away on their own, with little or no intervention.
However, in all cases where the situation persists or worsens, you should
consult with your child's doctor.
When a baby walks on tiptoe
Toe walking is common
for most children when they take their first steps. Tiptoe walking should be
gone by the time the child is 2-3 years old. Many children learn to tiptoe when
they first learn to walk. Only later, after about 6-12 months of practice, will
they learn to walk with a mature heel-to-toe gait.
In general, tiptoeing
is not a problem. But if toe walking persists beyond age 2 or is persistent,
seek advice from your child's doctor. Persistent walking on toes or on one leg
may be a sign of a central nervous system problem and should be evaluated.
Can flat feet delay walking?
Almost all children
are born with flat feet. It takes time for the natural arch of the foot to
form. Flat feet rarely cause walking problems and often disappear by 2-3 years
of age. Extremely flat feet can cause your child's ankles to bend inward as
they walk. This occurs if the arches do not fully develop to align the foot and
ankle. Treatment is rarely needed, except in the most severe cases, and is
usually not considered until the child is past infancy. The tendency to flat
feet can be inherited.
How serious is hip dysplasia in a baby?
During the first year
of life, a condition called progressive hip dysplasia may appear. This
condition causes the child's hips to grow in the wrong place due to weakened
ligaments and joints. Hip dysplasia can lead to delayed walking or other gait
problems. This is because hip dislocation can cause pain that gets worse with
exercise. Developmental hip dysplasia is a general term for a range of problems
with a child's hips. It can be found in about five out of every thousand
newborns. However, only one in 1,000 has a dislocated hip. At birth, the hip
joints and ligaments may initially be unstable on examination, but resolve most
quickly within the first few weeks.
For unknown reasons,
hip dysplasia is more common in older girls and in girls more often on the left
than on the right. Your child's doctor will check for hip dysplasia at birth
and at regular checkups thereafter.
If signs of hip
dysplasia are found during the examination, they will be closely monitored.
Signs include one leg that seems shorter than the other, uneven creases in your
child's hips or buttocks compared to the other side, and overly tight thighs.
The doctor will examine the hips to determine if the hip is dislocated or is
returning to the joint. Don't worry, the exam runs smoothly and can be a little
uncomfortable at worst. Hip dysplasia requires treatment, usually by a
pediatric orthopedic specialist, who usually first evaluates the hips with an
x-ray and/or ultrasound. Depending on the results, treatment can range from
continuous monitoring to special hip splints/splints, manipulation of the hip
joints under anesthesia, or surgery. Treatment also depends on the age of the
child.
Development milestones for a walk
Within 6-10 months:
Most children straighten up to stand.
From 7 to 13
months:
Most babies will be happy to "roll" around
furniture (as mentioned earlier).
Babies will be able to walk a little with the support of
a parent (note: early walking should not be forced).
11 to 14 months:
Babies begin to walk on their own - at 14 months, most
babies can walk on their own to some extent.
When to see a doctor for walking delay
Your child's legs,
feet, and motor skills will be tested as part of a routine healthy child visit.
But check with your child's doctor if you're concerned about walking delays.
Use the steps above and the following guidelines to help you recognize severe
developmental delays in your child.
Contact your child's
doctor if:
- Your child is not walking at 18 months
- Your child only walks on tiptoes
- You have other concerns about your child's feet and legs.
Any discrepancies in movement on one side of the body versus the other, or in favor of one leg, especially if they seem to be getting worse, should warrant a visit to the doctor.