Lower limb alignment in children
Parents are often concerned about the alignment of their child’s legs. Some children walk with their feet turned in and some with their feet turned out. Others have knock knees or bow legs. This article is Part 1 in a series will explain the different types alignments commonly seen by paediatric physiotherapists.
There are a number of things that affect lower limb development in the growing child
how tightly packaged they were in utero
genetics (take a look at your own legs!)
environmental factors like W sitting and how much exercise a child gets
Most children will show normal variations of these features and most will correct themselves in time.
Reassurance and monitoring is often the best approach.
However, there are times when an orthopaedic specialist should assess a child
when there are differences between the legs
if it is severe
if it is worsening
In toeing (pigeon toed)
This is a common concern reported by parents. There are generally 3 causes of in toeing and these occur at different ages
Birth Metatarsus adductus is due to tight packaging when in utero and is usually picked up at birth. It’s a complicated term that means the toes and forefoot are held in a turned in position. There is sometimes a bigger gap between the big toe and second toe and creases on the inside of the foot. In the majority of children, it resolves on its own or with stretches. Your physiotherapist experienced in paediatrics can show you these stretches as well as strengthening exercises, will provide advice on shoes and handling and play ideas to assist with the resolution of MA. In about 20% of children MA can be slow to improve. A splint worn at night can help stretch out the tight structures in these cases.
1-3 yearsMedial tibial torsion is also due to tight packaging when in utero but often goes unnoticed until children start to walk. Another complicated term which simply means that the tibia, or shin bone twists inwards. The legs can sometimes look bowed as well. Paediatric physiotherapists will measure the amount of torsion or twist and give some advice on positioning and shoes. Splints, braces and exercises don’t correct the twisting bone and most children will ‘untwist’ as they grow.
3-10 years Femoral anteversion. I know, another medical term. This one means the femur, of thigh bone twists inwards. It is more common in girls than boys. You may notice that your child trips more than their peers or run with their legs swinging outward. They may also W sit, have flat feet or lax joints. Some older children may complain of knee pain. There may be strength imbalances around the hip joint and your physiotherapist can assess for this. Like with most other causes of in toeing, braces and orthotics don’t speed up the natural correction of femoral anteversion.
Treatment
Just being a kid is usually treatment enough! Providing lots of opportunities to play, climb, run and jump allows the muscles around the hip, knee, ankle and foot to strengthen. Splints, braces and orthotics generally are not helpful. Specific strengthen exercises and stretches can help if there is a concern about gross motor skills or if the child is experiencing pain.
Remember – if there is a significant difference between sides, if it is severe or getting worse it is important you see your paediatric physiotherapist or doctor.
Part 2 - Knock Knees and Bow Legs Part 3 - Flat Feet in Children
Compiled by Cathy Molloy – Physiotherapist. March 2017
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