Toddler Q&A

Q:I have noticed that my 18-monthold daughter walks with her toes turned inward and her legs bent in at the knees. Is this normal in babies and will she grow out of it? If this is a problem I’d love to have some tips on how to correct it.

A:Your description of your daughter’s legs puts a picture in my mind of a very normal appearance for this age. The legs of children from two to three years of age are typically turned in at the forefoot, flat-footed with knees that are either knock-kneed or bandy, and hips that are rotated a little forward, and this gives them that typical toddler’s gait. The lower legs can also look like they are bent.

This is only a problem if: • it only occurs on one leg or foot • your child is in pain • your child is limping • your child is unsteady when walking

and trips a lot • walking is delayed • the problem clearly gets worse.

Flat-footed walking is not problematic and to be sure that the flat-footed appearance is not a permanent problem just get your child to stand on her toes. As children stand up on their tiptoes the arch of the foot is seen very clearly and this means that the foot will develop an arch once muscle strength has developed.

Using inner soles is of no value in this situation. Using inner soles means that the child has to wear shoes that hold the inner sole in place and your child will then have to be in shoes all the time, which is not a good idea.

The pigeon-toed appearance (the toes turned inward) will correct with time, and even if there is a small amount of in-toeing left when your child is older, this will not affect her gross motor development or abilities.

To see if the foot does correct into the neutral and normal position, just place your thumb on the sole of the foot and push the foot up towards the knee. You will see that the pigeon-toed appearance disappears. You will also notice that both the pigeon-toed and the knock-kneed appearance looks worse when your child is standing. This exaggeration with weight-bearing is normal as well.

We don’t really worry about the appearance of the legs until children are about three years of age. At three, it’s a good idea to have your child examined, with follow-up examinations over the next few years to ensure that the problems correct themselves.

Blount’s disease is one of the conditions that can cause bowing of the lower legs to worsen with time. This is a condition that only involves the tibia (the larger of the two bones of the lower leg) and causes no other problems at all. This is diagnosed by doing an X-ray, and surgical treatment may be necessary in severe cases.

Rickets is a condition that can cause abnormalities of the lower legs (usually bandy legs), short stature and problems with other bones like the ribs and the wrists. Many of the types of rickets are inherited and the condition is due to an abnormality in the production and development of bone, caused by a problem with calcium and phosphate metabolisation that involves Vitamin D.