When your child is born, you count off 10 toes and breathe a sigh of relief at the sight of his perfect little
feet. You wait with anticipation as he starts to take his first steps, now only to wonder if your toddler’s gait — the way he walks — is what it should be, and whether it is developing normally. “Once babies start walking, it’s important to note any irregularities or difficulties,” says Dr. Mario Turanovic, president of the Canadian Podiatric Medical Association and an Edmonton-based podiatrist. But that doesn’t mean you have to necessarily worry about every quirk.

“Toddlers have a different structure of their feet compared to adults, often leading parents and caregivers to believe that there’s a problem. Generally, this isn’t the case and the majority of chil-
dren don’t have gait or foot problems, but do walk differently,” says Dr. Barbara Grueger, a member of the Canadian Paediatrics Society’s (CPS) community pediatrics committee and a pediatrician in Whitehorse. “Most differences are developmental and will change as the child grows.”

toddling traits

• FLAT FEET (FALLEN ARCHES): Normal in toddlers, this occurs because foot muscles aren’t fully developed yet. However, once full heel-to-toe walking begins around age three or four, there should be an emergence of an arch. If not, a podiatrist should be consulted. “This holds especially true if there is a history of flat feet in the family,” says Dr. Turanovic.
• IN-TOEING (PIGEON-TOED) AND OUT-TOEING: Children can outgrow these developmental occurrences by late childhood (nine or 10 years), and there’s nothing to actually treat unless it’s interfering with activities, says Dr. Laura Purcell, a pediatric sports medicine physician in London, Ont., and president of the CPS’s pediatric sport and exercise medicine section. Either can happen due to a rotation in the foot, leg, thigh or hip. Occasionally, severe in-toeing may cause children to stumble as they catch their toes on the other heel. If your child sits on her legs in a V shape (calves under thighs, toes pointed inward) or in a W shape (bum on floor, legs bent at knee to either side), encourage her to sit cross-legged instead. “Katja, now 11, had turned-in feet from infancy, but at age two she could walk for two hours straight,” says Sarah Zbogar, an Oakville, Ont., mom of four. “We hoped that ballet would help turn them out but they remain the same, pointing in slightly. But at least she doesn’t trip much and she’s still a great hiker.”
• METATARSUS ADDUCTUS (MTA): This bending inward at the middle part of the foot to the toes, resembling the letter “C,” is another cause of in-toeing and is common among early walkers, says Dr. Turanovic. The majority of these cases will get better unless the inward bending is rigid. In these rare instances, “a podiatric physician can diagnose and treat MTA with serial casting, and in more severe cases, surgery,” he says.
• WALKING ON TIPTOES: It isn’t uncommon for babies to walk on their tippy-toes, ballerina-style, when they start out but it is not normal to persist once your child has mastered walking, says Dr.
  Turanovic. If tippy-toeing is your child’s major mode of walking, she may need to be assessed by her physician for potential issues such as tight posterior leg muscles or cerebral palsy.
• BOWLEGGED AND KNOCK-KNEED: Most babes are born bowlegged because of their folded position in the uterus. This normal developmental occurrence usually resolves itself by age two or three as
  children’s bones straighten out, says Dr. Purcell. At that point, most children develop the knock-kneed stance in which the legs angle slightly inward, lasting until age six or seven. However, if progressive bowing develops, discuss with your children’s doctor.

steps to take

• Show those toes: Allow babies to go barefoot at home as much as possible. If and when they do wear shoes for protection, “They should be well-fitting, soft, lightweight and should have cushioned soles,” advises Dr. Grueger.
• Watch and listen: Toddlers may not report how they’re feeling, so it’s up to you to look for signs of difficulty or discomfort. “Pain and limping are indicators of problems and should prompt medical evaluation. Any joint swelling, redness or heat over a joint or bone or refusal to walk or bear weight on the foot are also markers of potential relevant problems,” says Dr. Grueger.

Angela Pirisi is a health writer and mom who hopes that her daughter can escape the genetic double-whammy of bunions and in-toeing.