Common Childhood Orthopedic Conditions
As your child's body grows, you may notice that growth isn't occurring completely on the straight and narrow. Many young children exhibit flatfeet, toe walking, pigeon toes, bowlegs, and knock-knees in their first years of life.
Some of these conditions correct themselves without treatment as the child grows. Others that persist or become more severe may be linked to other conditions. Many orthopedic conditions, just like dimples or cleft chins, are just normal variations of human anatomy that don't require treatment.
Flatfeet
Most babies are born with feet that are flat, and arches grow as the child grows. But in some children who are born with flatfeet, the arch never fully develops. Parents often first notice their child has what they describe as "weak ankles." The ankles appear to turn inward because of the way the feet are planted.
Flatfeet usually do not represent an impairment of any kind for the child. Doctors do not recommend any special footwear, such as high-top shoes or shoes with arch supports, because these "treatments" do not affect arch development.
Parents with flat-footed children sometimes say their children are clumsier than other kids. But doctors say that flatfeet should be no cause for concern. Flatfeet shouldn't interfere with a child's ability to play sports. Typically, doctors only consider treating the child if the condition becomes painful. Doctors may give the child arch supports to insert into his or her shoes.
Toe Walking
Toe walking is common among toddlers when they are first learning to walk, especially during the second year of life. Generally, the tendency goes away by age 2, although in some children, it persists. Intermittent toe walking should not be cause for concern. But children who walk on their toes almost exclusively and continue to do so after the age of 2 should be evaluated by a doctor. Persistent toe walking in older children or toe walking on one leg but not the other may be linked to other conditions, such as cerebral palsy or other problems with the child's nervous system.
Persistent toe walking in otherwise healthy children occasionally requires treatment, such as casting the foot and ankle to help stretch the calf muscles for about 6 weeks.
Pigeon Toes
Pigeon toes, or inwardly turned feet, are another normal variation in the way the legs and feet line up. Babies may have a natural turning in of the legs at about 8 to 15 months of age, when they begin standing. Special shoes and braces (commonly used in the past to treat this problem) have never been shown to speed up the natural slow improvement in this condition. Treatment for pigeon-toed feet is almost never required. It is usually due to persistent in-turning of the hips. The medical name for this condition is femoral anteversion. This, too, typically doesn't interfere with walking, running, or sports, and resolves on its own as kids grow into teens and develop better muscle control and coordination.
Bowlegs
Bowleggedness (the medical name for this is genu varum), an exaggerated bending outward of the leg from the knee downward, can be inherited. It is commonly seen in infants, and in many cases, it corrects itself as the child grows. Bowleggedness beyond the age of 2 or bowleggedness that only occurs in one leg but not the other can be the sign of a larger problem, such as rickets or Blount disease.
Rickets is a bone growth problem, usually caused by lack of vitamin D or calcium in the diet, and evidenced by severe bowing of the legs and may include muscle pain and enlargement of the spleen and liver. Rickets is much less common today than it used to be. Rickets and the resulting bowlegs are almost always corrected by adding vitamin D and calcium to the diet. Some types of rickets, however, are due to a genetic condition, and may require more specialized treatment by an endocrinologist.
Severe bowlegs can also occur as a result of Blount disease, a condition that affects the tibia bone in the lower leg. Bowing from Blount disease is seen when a child is about 2 years old and can appear suddenly and become rapidly worse. The cause of Blount disease is unknown, but it causes abnormal growth at the top of the tibia bone by the knee joint. To correct the problem, the child may require bracing or surgery between 3 and 4 years of age. You should also take your child to the doctor if the bowlegs occur only on one side or get progressively worse.
Knock-Knees
Most kids show a moderate tendency toward knock-knees (the medical name for this is genu valgum) between the ages of 4 and 6, as the body goes through a natural alignment shift. Treatment is almost never required as the legs typically straighten out on their own. Severe knock-knees or knock-knees that are more pronounced on one side may require treatment on a case-by-case basis.
Updated and reviewed by: Robert P. Stanton, MD