Delayed Walking and Other Foot and Leg Problems in Babies

Most babies can pull themselves up to stand and begin taking their first steps somewhere between the ages of 8 months and 18 months. Soon after their first birthday, they can usually take a few steps alone, but prior to this will have started to 'cruise' -- walking along the edge of a couch or table, using furniture or outstretched hands for support. But what if your baby shows signs of delayed walking? And what if you notice your baby has bowed legs or is walking on tiptoes -- should you worry?

There is a wide variation from one baby to the next in learning to walk. Timing of first steps can also vary between babies of different ethnic backgrounds. One baby may not walk until three or four months after another baby has walked. That doesn't necessarily signal a problem or delayed 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?

Bowed legs are a common concern of new parents who may not realize that nearly every baby has bowed legs at birth. This outward curve of the leg bones usually resolves itself by age 2. Toddlers usually sway from side to side rather than move forward, at first, making their bowed legs look even more exaggerated. Bowed legs don't cause delayed walking or affect your baby's ability to learn to walk.

In a few rare cases, when bowed legs don't resolve naturally by age 2, your baby's knees can be turned outward by the curve of the leg bones. This can cause knee problems. If bowed legs appear suddenly or persist beyond the age of 2, see your baby's doctor.

Rarely, bowlegs are a sign of rickets. That's a condition caused by, among other things, a lack of vitamin D and calcium in your baby's diet that inhibits bone growth. Bowlegs can also be caused by a relatively rare condition called Blount's disease, which causes abnormal bone growth in the tibia, or lower leg bone. This condition is more commonly seen in African-American children and is thought to be associated with being overweight.

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Are Pigeon Toes a Problem for Babies?

Many babies have a slight intoeing, also called pigeon toes, when they're born. This usually disappears during the toddler years.

Pigeon toes may be caused by problems with any of three areas in the leg and foot. There may be deviation of the foot called metatarsus adductus. There may be problems at the head of the thigh bone at the hip. Finally, this could be due to problems in the tibia or lower leg bone -- internal tibial torsion.

Metatarsus adductus seen in infants tends to go away by the time a child begins walking. This is a curve in the foot itself, usually created by the baby's position in the womb before birth, although there are other possible factors. You can see metatarsus adductus when you look at the soles of your baby's feet. They'll curve towards each other like two half-moons.

Doctors disagree about whether to put foot braces on a child with severe pigeon toes. Some doctors advise bracing or casting if the feet are still severely curved when a child is between 4 and 6 months old. The brace or cast is usually removed when a baby starts to walk. Other doctors don't feel that bracing helps pigeon toes or speeds up the development of the feet and legs toward a more true alignment.

If your baby's knees point straight ahead with intoeing, he may have internal tibial torsion, which is more commonly seen at the ages of one to three years. This condition is caused by an inward turning of the tibia (lower leg bone). It usually resolves itself as a baby learns to walk. If it doesn't, see your doctor for possible treatment.

If your baby's knees point inward with intoeing, he may have a condition called excess femoral anteversion. This condition is caused by an inward turning of the femur (upper leg bone) and is often seen in children who sit with their lower legs behind them in a W shape. Again, it usually resolves on its own -- typically by age 8 or so.

All of these conditions usually disappear on their own, with little or no intervention. However, in all cases where the situation is persistent or worsening you should consult your child’s doctor.

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When Baby Walks on Tiptoes

Toe walking is common for most babies as they take their first steps. Walking on tiptoes should disappear by the time a child is between ages 2 and 3. Many babies practice walking on tiptoe as they are first learning to walk. Only later, after 6 to 12 months or so of practice, will they learn to walk with a mature heel-to-toe gait.

Usually walking on tiptoes is not a problem. But if toe walking persists beyond the age of 2 or is done constantly, see your child's doctor for advice. Persistent toe walking, or toe walking on only one foot, can be a sign of a central nervous system problem and should be evaluated.

Can Flat Feet Delay Walking?

Just about every baby has flat feet at birth. It takes time for the foot's natural arch to develop. Flat feet rarely cause any problem with walking and often disappear by ages 2 or 3. Extremely flat feet can make your baby's ankles appear to bend inward as he or she walks. This happens if the arches don't fully develop to realign the foot and ankle. Treatment is rarely needed except in the most severe cases, and is not generally considered until a child grows past the early infant years. A tendency to flat feet can run in families.

How Serious Is Hip Dysplasia in a Baby?

During the first year of life, a condition called developmental hip dysplasia may appear. This condition causes a baby's hips to develop in the wrong location because of overly relaxed ligaments and joints. Hip dysplasia can lead to delayed walking or other walking problems. That's because a dislocated hip can cause pain that's made worse during weight-bearing. Developmental hip dysplasia is a general term for any number of problems with a baby's hips. This can be found in about five of every thousand newborns. Only about one in 1,000, though, actually has a hip dislocation. At birth the hips and ligaments may be initially unstable on examination but most quickly resolve in the first weeks.

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For unknown reasons, hip dysplasia is more common in first-born baby girls and on the left rather than the right. Your baby's doctor will check for hip dysplasia at birth and during later regular checkups.

If there are any signs of hip dysplasia at an exam, they will be followed up closely. Signs include one leg looking shorter than the other, unequal creases in your baby's thighs or buttocks compared to the other side, and overly stiff hips. The doctor will examine the hips to feel whether the hip dislocates or pops back into the joint. Don’t worry -- the exam is done gently, and at worst may be a little uncomfortable. Hip dysplasia requires treatment, usually by a pediatric orthopedic specialist who will usually first assess the hips with X-rays and/or an ultrasound. Depending on the findings, treatment may range from continued observation to special hip braces/splints, manipulation of the hips under anesthesia, or surgery. Treatments also vary depending on the age of the baby.

Developmental Milestones for Walking

By 6 to 10 months:

Most babies will pull themselves up to stand.

Between 7 and 13 months:

Most babies will be happily 'cruising' around the furniture (as mentioned before).

Babies will be able to walk a little with support from a parent (note: early walking should not be forced).

Between 11 and 14 months:

Babies will start to walk alone -- by 14 months most babies will walk alone to some degree.

When to See a Doctor About Delayed Walking

Your baby's legs, feet, and motor skills will be checked as part of the normal well-baby visit. But see your baby's doctor if you're concerned about delayed walking. Use the above milestones and the following guidelines to help you recognize any major delay in your baby's development.

See your baby's doctor if:

Your baby isn't walking by 18 months

Your baby only walks on his or her toes

You have any other concerns about your baby's feet and legs

Any differences between the movements of one side of the body compared with the other, or favoring of one leg, especially if they seem to be getting worse, should prompt a visit to the doctor.


 

WebMD Medical Reference Reviewed by Dan Brennan, MD on July 16, 2017

Sources

SOURCES:

American Academy of Family Physicians: "Common Childhood Orthopedic Conditions;" "Intoeing;" and "Flat Feet in Children."

Nemours Foundation: "Movement, Coordination, and Your 8- to 12-Month-Old" and "Movement, Coordination, and Your 1- to 2-Year-Old."

American Academy of Pediatrics : "Developmental Milestones;" "Assure the Best for Your Baby's Physical Development;" and "Hip Dysplasia."

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