In clinic we see many paediatric (children) patients who present with their parents/care givers; we are frequently asked if their walking development is “normal” and when concern should be given. In order to help answer these questions this article provides some detail as to paediatric foot and gait development and explains why their walking pattern may look a little different to that of an adult.
Children present a unique presentation in clinic as the goals of the child, parent and clinician may differ causing potential problems when planning their care management. Children’s foot function and development changes dramatically during the first few years of life. The impact to the foot by the change of posture in the transition from crawling to walking is predominated by the development of the longtitudenal arch (the arch running from the heel to the base of the toes), an increase in the pressure the foot withstands and a change in where this pressure is placed. Children develop walking mechanics at different rates; as always there is variation amongst individuals and although this can be an area of concern to parents, it is completely normal.
Children use their feet in different ways to adults too. We recognise that the shape the foot produces when it impacts the ground (roll over shape) does not become “adult like” until the age of at least 3 and in according to some research not until the age of 5. Their walking (gait) pattern also varies mainly due to the difference in how much the ankle moves; recent literature comments that this variability may persist until the age of 9!
As a child matures and becomes more experienced in their ability to walk their speed becomes more variable and generally increases. Many children even after only a few months of walking are capable of occasionally supporting their body on one leg as well as maintaining their balance during walking.
In clinic, we assess children’s walking using many methods including that of direct observation, videotaping (with consent) and parental reports. Observation is a reliable method of assessment; however, children’s behaviour may cause these results to be somewhat variable! Video recording is useful especially with slow motion playback as it allows multiple play backs without upsetting or causing tiredness in the child. We value parents reporting and case history as this gives many clues as to the presenting problem, examples of this would be reported age of unaided independent walking. We frequently liaise (with permission) with other healthcare professionals involved in the care of your child. This often includes paediatricians, podiatrists, physiotherapists and health visitors.