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Lower Limb Appearance & Movement in Children

Written by Gillian Finch, 4 Life Physiotherapy

There are many different concerns we have as parents with how our children look and move. There is a huge variation in normal appearance and movement of children’s bodies just like there is between adults.

As children grow, they change in height, size and how their limbs look and move. Many of the changes that occur through the infant and toddler stages are the unwinding of the lower limbs from being in the womb. As toddlers learn to walk and weight-bear they transition through different leg postures. Initially standing and walking with their knees and feet in a wide base of support, then as balance improves, they progress to a narrower base of support.

You may have heard the terms “bow-legged” “knock knees” “flat feet” “in-toeing” “out-toeing” and wondered if your child has characteristics of these. Let’s explore what is considered normal variations as children grow:

Bow-legged - where the knees curve outwards while the ankles are closer together, this can be a normal appearance and starts to slowly improve around 18 months of age.

Knock knees – where the knees are closer together in standing than the ankles, is a common appearance, most often noted around 3-4 years of age and can be a normal developmental stage in children up to 7 years of age.

Flat feet – where the arch of the foot sits very low. Almost all babies have flat feet with no arch present due to a fat pad beneath the arch. The arch usually develops between the ages of 4-8 years as muscular control and stability improve.

In-toeing – where the toes point in, often called pigeon-toed. This can be due to foot, knee, or hip positioning. This is commonly seen when toddlers start to walk, they may seem clumsy on their feet, tripping over, this normally improves as the child gains strength and control.

Out-toeing – where the toes point out while standing and walking. This is normal in babies and usually lessens by the age of 2 years as balance control improves.

All these variations can be normal, however, there are some occasions where the leg presentation is indicative of an underlying condition. It can be difficult to know when your child needs to be assessed by a health professional. Here are some tips to help guide you:

  • First and most important: you know your child best and if something is worrying you it is worth being investigated further.

  • Is this a new or progressing change?

  • Is one side looking or moving differently to the other?

  • Are you noticing this movement happening more often?

  • Has anyone else raised concerns with you?

  • Is your child complaining of pain or not wanting to be active?

If you would like a health professional to assess your child, it is as simple as booking an initial appointment with a physiotherapist for further advice.

What to expect at your child’s physio appointment? The physio will

  • Find out your concerns, ask questions about your child’s health and development, their daily activities, sleep, family.

  • Observe and evaluate your child’s movements, strength and function through activities and hands-on assessments to identify what is causing the concern.

  • Clearly explain to you their findings and the treatment process if treatment is needed.

  • Liaise with your GP if further investigation or referral is needed.

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