5 Common Childhood Orthopedic Conditions that Shouldn’t Worry Parents
Polly Wimer, Orthopaedic Pediatric Nurse Practitioner, Orthopaedic Surgery
As toddlers grow and become more active, parents may notice the child’s legs aren’t perfectly straight. Many young children have intoeing, bowlegs, knock-knees, flatfeet or walk on their tip toes. Being concerned is normal for any parent but the good news is these common conditions usually correct themselves over time without medical intervention.
Intoeing or “Pigeon Toed”
Intoeing is very common in children. In fact, it’s one of the most common conditions we see in the Orthopedic Department at Children’s Mercy. Intoeing is when a toddler walks or runs with the feet turned inward instead of pointed straight. Most parents tend to be concerned or worried, but there’s usually no reason to be alarmed. An overwhelming majority of children will outgrow intoeing, without any treatment, before turning 6 years old.
Here are the three common conditions that cause intoeing:
- Twisted Thighbone (Femoral Anteversion) Femoral anteversion is the most frequent cause of intoeing in children. This is when the child’s thighbone turns inward and the knee and foot twists toward the midline of the body. This type of intoeing is more common in girls, and is most noticeable in children between the ages of 4 – 6 years old. Research has shown that interventions such as special shoes, bracing and exercises are not helpful, and the condition will naturally correct as children mature developmentally. Children with femoral anteversion often prefer the “W” sitting position due to comfort and this should not be discouraged. We recommend going barefoot as much as possible to help with overall proprioception and balance.
- Twisted Shin (Internal Tibial Torsion) Internal tibial torsion occurs when the child’s lower leg twists inward. This usually occurs before birth, as the legs rotate to fit in the confined space of the womb. After birth, an infant’s legs should gradually rotate to align properly and almost always improves without treatment by the age of 3-4.
- Curved Foot (Metatarsus Adductus) Metatarsus adductus occurs when a child’s feet curve inward from the middle part of the food to the toes, and typically improves on its own over the first and second years of life.
Bowlegs are described as a child having rounded legs while standing with the feet together. The knees are bowed outwards, far apart from one another. Most children are bowlegged from birth until age 3. So if your child is under age 2, in good health, and has the same amount of bowing in each leg then there is no reason for concern. Your doctor may want to check for Blounts disease or Rickets if one leg is severely bowed more than the other and your child is over 2 years of age.
Knock-knees when the child stands with the feet far apart, but the knees still touch. Most bowlegged children will become knock-kneed from age 3 until the age of 5. The legs usually straighten by age 7.
All children are born with very little arch in the feet and this is considered to be normal. When a child with flatfoot stands, you can’t see the arch of the foot. While some children will never develop an arch related to their family history and genetics, some children will begin to develop an arch at 6 years of age. Special shoes or inserts will not change the development of your child’s feet. Having flatfeet is usually painless and does not impact walking or sports participation. If your child is having pain in their feet at any age we recommend evaluation.
Toe walking is common among toddlers as they learn to walk and the condition often goes away by age 3-4. As the child grows and gains weight their heels should begin to touch the floor. Occasional toe walking shouldn’t be cause for concern, but kids who walk on their toes almost all the time and continue to do so after age 4 should see a doctor.
If an otherwise healthy child has persistent toe walking, the doctor might recommend casting the legs and working with physical therapists to learn stretching exercises.
When to See a Specialist
If your child is otherwise healthy, but you’re still concerned about their legs, your primary care doctor may recommend an x-ray. However, you’ll want to wait until the child is at least two years of age before having an x-ray to get the most accurate diagnosis. The only reason a child would be seen before two years of age is if the child was born premature. Doctor’s will want to check the child’s muscle tone and determine if there are any developmental delays.
All these conditions are almost always a variation of normal, and parents shouldn’t worry. Most children won’t even develop an “adult” gait until they’re 6 or 7 years old. Evidence-based research and studies have shown that the best treatment is to watch and wait. As a parent, we know it is hard to wait when you think there might be something wrong with your child, however as an expert in orthopaedics, seeing children for over 20 years with these common issues, we can assure you that watching and waiting is okay.
Learn more about Pediatric Orthopedics at Children’s Mercy.