During the baby’s first and subsequent physical examinations, the assessment of the hips is important. This is to ensure that the hips are not dislocated. Congenital or developmental dislocation of the hip occurs in up to 2 percent of newborns. By moving the legs in certain ways while feeling the hip joint area for a clicking noise, the healthcare provider can make the diagnosis. Once there is a suspicion of hip dislocation, X-rays may be needed and the child will be evaluated by a pediatric orthopedic surgeon. The treatment is usually the placement of the hips in a harness or cast, usually for four to six weeks, depending on the individual situation. Left untreated, congenital hip dislocation can result in long-term consequences such as walking problems and arthritis.
During the first two years of life, normal babies are bowlegged, in other words, their knees are far from each other. This is referred to as genu varum and is normal. Between their third and fourth years, children’s knees start to curve inwards to touch each other or become knock-knees (genu valgum). After this, the knees return to a position somewhere in the middle. Again, this is part of normal leg development. As children get older and if knock knees persist and are significant, they can be evaluated by an orthopedic surgeon.
In-Toeing and Out-Toeing
“In-toeing” is when the leg or foot points inward and “out-toeing” is when the leg or foot points outward. Both are common in babies and young children. These foot concerns almost always go away on their own without any future significant walking or related problems. When we evaluate these children, we look at three possible sources: the hip, the knees, and the feet. The approach and treatment, if any, will vary depending on the source, the location, and the nature of the cause. In very rare cases, if the rotation persists beyond eight years of age and is associated with foot pain or walking difficulties, surgical repair may be required. Reassuringly, however, the vast majority of these foot rotations go away spontaneously.
It is not uncommon for toddlers to walk on their toes. In the vast majority of cases, this is normal and not a sign of any problems. Very rarely, it can be a sign of a “tight” Achilles tendon or heel. Your healthcare provider can easily assess this. In mild or early cases, stretching exercises will solve the problem. If the problem is more severe and stretching has not helped, referral to an Orthopaedic specialist may be necessary. However, it is comforting to know that in most cases there is no associated muscle, tendon, or foot problem, and no treatment is required.
RELATED TOPIC: Clubfoot
Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.