Disclosure :: this post is sponsored by Children’s Hospital of New Orleans.
“Her feet turn in.”
“She’s tripping and falling a lot.”
“He’s really bowlegged or knocked kneed.”
The infant, toddler and early walking child undergo a lot of changes to their lower extremities. Children are often born with rotational variations to their lower extremities that can influence the overall alignment of their legs. These rotational variations often occur in utero when the child is no longer able to move freely within the uterus. This leads to the common rotational variances called tibial torsion and femoral anteversion. These changes to our anatomy are present at birth but become more apparent as you child starts to run. The child in early walking often adapts to the rotational changes by holding their legs in or out. As the child moves faster, the immature brain is not coordinated enough to hold the legs corrected and go fast. So in these instances, the child increases their speed and because of the lack of coordination, the feet turn in and they trip and fall.
Mythbuster :: Does my child need braces or special shoes?
The most common age we see start seeing children in our practice is between roughly 18 months to 2 ½ years of age. The most common reason for presentation is because their grandmother is worried that they need braces. When we were children, it was common practice to use special shoes, reversed shoes, and orthotics for these conditions. Today, we have found these devices do not speed or change the process or affect the need for surgical intervention (this is a very rare occurrence). Through the natural process of becoming coordinated and with increased muscle strength, the bones naturally untwist over time. This usually occurs between 5-8 years of age dependent on child and location of the twist. Sometimes it takes some convincing to change the mind of someone who has seen bracing apparently work in the past. I even had to show my own wife the literature to prove it.
Changes in walking and running styles, along with different ways of sitting (ie. W sitting), are results of the rotational changes and not causes. These preferences will go away as the lower extremity’s rotation changes and will not make it worse. The only thing that propitiates the rotational changes is an underlying neuromuscular condition, which is rare. These do not usually become apparent until after age 3 and more commonly after age 4. Often these conditions also present with the inability to keep up with other kids their age and regression (the inability to do something they could do before).
What to look for as a mom:
Rotational changes may cause the lower extremities to appear bowlegged or knocked kneed. This is the body’s adaptation to try to walk and run efficiently.
- To see if your child has pathologic bowlegged or knocked knee deformity, have them lie back, cover up their feet, hold their legs together, and point the knee caps forward. If there is more than a hand’s width between the knees or ankles, then we need to see them.
- If your child has significant bowing of the legs after 2 years of age, then we need to see them.
- If they have maintained the rotational changes, you have seen regression with their milestones, or they have pain associated with the condition, then we need to see them.
The information contained in this blog post is for networking and informational purposes only, and should not be used to replace the relationship that exists between you and your child’s healthcare provider. Please contact your healthcare provider for specific medical advice and/or treatment recommendations.**
About Dr. Joseph Gonzales
Dr. Joseph Gonzales is a fellowship-trained pediatric orthopedist and director of the Children’s Hospital Orthopedics Department. Dr. Gonzales lives on the Northshore with his wife and two daughters.
Children’s Hospital’s Orthopedics Department has the largest and most experienced group of fellowship-trained pediatric orthopedists in the region with the expertise to care for every boo-boo, break and tumble. To learn more about the department and services offered, visit the Children’s Hospital web site.