June 23, 2021

Walk This Way: Common Gait Issues In Children

Talking about two common gait issues in children and how physical therapy can help

Key takeaways:

  • Babies begin to walk anywhere from 8 -15 months
  • Children usually have a proper gait (heel to toe) by around 15-18 months
  • Many children can walk up stairs one at a time and jump in place by age two, which is when you might notice different gait patterns.
  • Common gait issues include toe walking, flat feet, intoeing, bow legs, and knock knees

One common issue we see in young children is atypical walking, stepping, or running, otherwise known as a gait problem. Several conditions can affect how children walk and develop. As a parent, you may wonder if your child has a gait issue and if so, what can be done about it.

We discuss common gait issues, how they are assessed, and how physical therapy can help.

From baby to toddler

New parents celebrate many milestones in that first year or so of life. One of the most momentous is when your baby takes his or her first steps. Babies can begin to walk as early as eight months but most begin around 11 to 15 months. There is usually a natural progression from first steps to confidently walking with little or no support. Babies usually start walking in the following ways:

  1. Wide gait to aid in balance/support
  2. Rapid steps
  3. Short steps
  4. Holding out arms to maintain balance
  5. Legs rotating with some bowing
  6. Flat feet with no evident arch

Most children do not start using a proper gait (heel to toe) until about 15-18 months. By age two, most can walk up stairs one step at a time and jump in place. Mature gait patterns usually develop in the early school years. During this time, you may notice different gait patterns or presentations.

Let’s look at two of the most common gait issues.

Gait Issue 1: Toe walking

Toe walking is defined as a failure of the heels to touch the floor while walking. A child may start by walking on their toes; however, this should resolve within one or two months to the heel-toe gait pattern. If not, outside support may be necessary to prevent future complications. Idiopathic Toe Walking (ITW) is toe walking that doesn’t have a known pathological cause.

Toe walking is not always a cause for alarm in children but if it continues there could be an underlying neuromuscular or musculoskeletal condition.

Some causes of continued toe-walking including:

  • Cerebral palsy
  • Congenital contracture of the Achilles tendon
  • Paralytic muscular disorders (muscular dystrophy)
  • ITW
  • No known cause
  • Sometimes associated with developmental disorders such as autism, sensory processing disorders, etc

Toe walking may also be associated with hypersensitivity to touch. For instance, some children don’t like to feel certain surfaces on their bare feet so they go up on their toes to avoid contact with the floor.

Gait Issue 2: Flat feet

Flat feet, or pes planus, is another common gait issue. It can present as the turning in or out of the foot or feet when a child stands or walks with no arch present. Often, you’ll hear an audible foot slap on hard surfaces. There may also be an unusual wear pattern on one side of your child’s shoes.

Over time, children with flat feet may overcompensate and roll one foot in too far. This leads to an uneven distribution of body weight, which might cause excess strain on the hips, knees, and ankles. The chances of developing pain and serious orthopedic issues later in life are likely.

Other common gait issues are:

  • Intoeing
  • Bow legs (genu varum)
  • Knock knees (genu valgum)

Assessing and treating gait issues

Your child’s pediatrician should conduct regular gait assessments. You might notice certain issues and request additional assessments.

Gait assessment can include:


  • Looking at medical/family history
  • Factors surrounding pregnancy/birth/development
  • Perinatal events and motor development
  • Duration, progression, and severity of the issue
  • True gait issue vs. the appearance of one
  • Assessing symptoms and signs
  • Assessing sitting, standing, and walking habits

Musculoskeletal assessment

  • Spine, pelvis, lower extremities, hips, legs, knees, ankles, feet/arches
  • Postural assessment

Neurological assessment

  • Testing reflexes, sensation, balance, muscle tone, muscle strength, ruling out neurological conditions

Children with serious neurological/musculoskeletal/developmental issues may require more invasive types of treatment, from surgery to wearing body casts. Less severe cases will benefit greatly from physical therapy alone. Some children require a combination of both.

Physical therapy can include exercises such as:

Passive range of motion

  • Calf stretching
  • Hamstring/knee flexion and extension

Active range of motion

  • Animal walks (bear, crab, frog, penguin)

Strength exercises

  • Weight-bearing activities
  • Sensory integrations

Finding help at Lumiere Children’s Therapy

Lumiere Children’s Therapy applies a team-based approach to physical therapy. We focus on helping children develop muscle strength, balance, and a proper gait. Children receive physical therapy in the form of play so that sessions are fun, which helps to boost your child’s confidence. Every child is evaluated and given a personalized treatment plan to help him or her gain the necessary skills.

Along with gait issues, we also help kids with:

  • Gross motor delays
  • Generalized muscle strengthening
  • Body awareness
  • Coordination skills
  • Functional skills, such as stairs
  • Neuromotor reeducation following traumatic injury (spinal cord or brain injury)
  • Sports injuries (fractures, strains/sprains)

Lumiere Children’s Therapy provides other comprehensive therapies for children with a wide range of physical, emotional, and developmental conditions.

Our services include:

  • ABA (Applied Behavior Analysis) Therapy
  • Speech therapy
  • Occupational therapy
  • Developmental therapy
  • Augmentative alternative communication
  • Early intervention
  • Teletherapy
  • Social work

Lumiere Children’s Therapy is a full-service, multidisciplinary pediatric therapy practice located in Chicago that serves the developmental needs of children from birth to 18 years of age. Learn more about how our team of clinicians works to improve the lives of children and their families.

Contact us to learn more.

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