What is Typical Leg Alignment in Early Childhood?
by Jeanette Mangano, DPT
Kids Place West Pediatric Physical Therapist
Your child will go through many significant changes in the structure and alignment of their legs throughout their development. Alignment is an important contributing factor to your child standing and walking. Often, parents will ask me if their child’s legs are aligned properly. The following information is based on normal development of a child.
Infants are initially over-flexed with their hips and knees bent in a position commonly known as the “fetal position.” By placing your infant into tummy time, your child should quickly move out of the flexed position and develop their extensor muscles (the muscles on the back side of their trunk and legs).
When babies start pulling to stand, the alignment of their hips is still slightly flexed and rotated in with their legs bowed. Their feet are placed far apart from one another to increase their base of support due to decreased standing balance. They are flat-footed and bear weight through the entire bottom of the foot. As they begin to cruise along furniture, they begin to strengthen the muscles on the sides of their hips.
Once your baby stands and walks without support, the alignment will again shift. They will continue to have feet far apart to increase their base of support and their hips wide and rotated outwards with their arms out to the side. They keep their hips and knees slightly bent and land flat footed without an arch in their foot.
At 18 months, or approximately 6 months after the onset of independent walking, the knees become straighter and less bowed. Children are more upright and able to extend their hips more than previously. They no longer demonstrate excessive movement of their hip out to the side.
Around 3 years of age, you will see children’s alignment change to appear more knock-kneed. The rotation of the bone in the upper leg continues to be twisted when compared to adult alignment. The arch of the foot is mostly developed at this point.
By 7 years of age, alignment has normalized to appear more like an adult alignment. The walking pattern is mostly mature, though some factors will continue to develop through 10 to 12 years of age.
Typical alignment is legs mostly straight with some bowing or knock-kneed alignment and mild out-toeing. If you look from behind the heel of a 7 year old, you should see 2 to 2 ½ toes outward, which is the normal amount of out-toeing. A walking pattern is mostly mature by about 4 ½ years of age with other changes due more to growth.
If you have specific concerns about your child’s alignment or walking patter, a Kids Place pediatric physical therapist can perform a full evaluation to determine whether your child falls within normal ranges or can benefit from treatment.