A toddler is categorised as being between 12 to 36 months old, and parents of toddlers are often unsure about what is normal for their child’s foot development. Here are some typical milestones to look out for and common complaints. If you notice a delay in milestones or regression, you should visit a specialist podiatrist or paediatric team as this can sometimes signal neuromuscular or metabolic problems.
From age of 12 months the child will begin to walk, initially with a wide base to increase stability, externally rotated gait and short steps. This then progresses through orderly stages of development.
Stages of development involve gradual increase in velocity, stride and single limb stance time. The stages will have some variation based on family history and race; African black children tend to walk sooner, Asian children later than average, and bottom shuffling children tend to walk later.
- 12 months: Can walk with assistance – holding on to furniture and taking the occasional step unsupported.
- 15 months: Can walk well without assistance with wide-based gait
Heel striking begins between 15-18 months with reciprocal arm swing
- 18 months: Can run without assistance with wide based gait
*Concern if not walking by 18 months – see a specialist podiatrist or paediatric department
Bowed legs – it is common for children to have a small gap between their knees and ankles when they stand before 18 months of age. If this is pronounced or isn’t correcting itself, see a specialist podiatrist or paediatric department.
- 24 months: Can go up and down stairs without assistance using 2 feet per step. Waddling gait is developed.
Running and changing direction develops after 24 months, which involves regular falls as the child develops balance and coordination.
- 30 months: Can jump on both feet and may walk on tip toes.
*Concern if they cannot jump by school age.
- 36 months: Can stand on one foot for a short period. Can climb stairs using one foot per step and come down using two feet per step.
*Concern if waddling beyond 3 years – if present look out for tip-toe walking and a protruding belly (lumbar lordosis) as a method of trying to keep balance.
By 36 months, a mature gait pattern should be established.
The bones of a child are soft and their feet grow fairly rapidly. They will not require good footwear until they are walking on their own but, when they do, you should make sure there is enough space in the shoes, that the heel remains in place and to not squash the toes.
Knock knees – When standing, the knees are close together but ankles are apart. This usually corrects itself by age of 7. However, sometimes this is sometimes attributable to flat feet and hypermobility where the child feels unstable and may develop discomfort in their knees. If this is the case, see a podiatrist as orthoses (insoles) may help.
In-toeing – While walking, the child’s feet point inwards (also known as pigeon toed). This usually corrects itself by the age of 8. However, sometimes children need some help with this. A custom orthotic device (insole) can be made with out-toeing gait plates to promote out-toeing.
Out-toeing – While walking, the child’s feet point outwards. This usually corrects itself by the age of 8. However, sometimes children need some help with this. A custom orthotic device (insole) can be made with in-toeing gait plates to promote in-toeing.
Flat feet – It is normal for toddlers to have flat feet. Arches gradually develop up to the age of 6. An arch will usually form when they go up on to tip toes. If the child seems unstable or is in pain when walking then see a specialist podiatrist for an assessment. They may benefit from orthotic devices in their shoes.
Tiptoe walking – Under the age of 3 it is common for children to walk on their toes.
By, Senior Podiatrist, Steven Thomas