Posted by: Indonesian Children | August 15, 2009

Normal gait patterns IN Children

The toddler has a broad base gait for support, and appears to be high stepped and flat footed, with arms outstretched for balance. The legs are externally rotated, with a degree of bowing. Heel strike develops at around 15 to 18 months with reciprocal arm swing. Running and change of direction occur after the age of 2 years.

In the school-age child, the step length increases and step frequency slows. Adult gait and posture occur around the age of 8 years. There is a considerable variation in normal gait patterns and the ages at which the changes occur; and appear to be family-history related. Black children tend to walk sooner and Asian children later than average.

Normal variations

  • Leg alignment varies with age and is often influenced by a family history of the same pattern.
  • Habitual toe walking is common in young children up to 3 years. In-toeing can be due to persistent femoral anteversion and is characterised by the child walking with patellae and feet pointing inwards (common between the ages of 3 and 8 years).
  • Internal tibial torsion is characterised by the child walking with patella facing forwards and toes pointing inwards (common from onset of walking to 3 years).
  • Metatarsus adductus is characterised by a flexible “C-shaped” lateral border of the foot. Most resolve by the age of 6 years.
  • Bow legs (genu varus) are common from birth to early toddler-hood, often with out-toeing (maximal at approximately 1 year). Most resolve by 18 months.
  • Knock knees (genu valgus). Often associated with in-toeing. Most resolve by the age of 7 years.
  • Flat feet. Most children have a flexible foot with normal arch on tiptoeing. Flat feet usually resolve by the age of 6 years. View image
  • Crooked toes. Most resolve with weight-bearing.

Causes for concern are if these normal variations are persistent (i.e., beyond the expected age range), if changes are progressive or asymmetric, or if there is pain and functional limitation or evidence of neurological disease.

In children with bow legs or knock knees, it is important to consider x-rays if the child is short (a height less than the 25th centile raises suspicions of hypophosphataemic rickets or skeletal dysplasias) or has genu varum or asymmetric leg alignment.


Supported  by

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia

phone : 62(021) 70081995 – 5703646

email :,



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Copyright © 2009, Clinical Pediatric Food Allergy Information Education Network. All rights reserved.


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