Walking, also known as “gait,” is a mobility skill typically achieved by most children between 8 and 17 months of age. An atypical walking pattern, or gait deviation, is when a child walks in a way (or has a walking pattern) that is atypical (different or unexpected) for their age or stage of development.

If your child walks differently than their same-age peers, such as walking with their toes turned in, up on their tip toes, or crouching at the knees, this may be considered a gait deviation. Children with suspected gait deviations should be assessed by a pediatrician or a physical therapist.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can see a physical therapist directly for evaluation and treatment without a physician’s referral.* To find a physical therapist in your area, visit Find a PT.

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*A referral may still be required by your insurance policy, corporate policies, or state practice laws (some states limit the type of treatment or number of visits without a referral).

On this page

• What Are Atypical Pediatric Walking Patterns?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Are Atypical Pediatric Walking Patterns?

A gait deviation is an unusual walking pattern or way of moving the legs or body when walking. Not all gait deviations are a cause for concern. For example, most babies are flat-footed and have bowed legs when they start to walk, with leg position straightening out by age 2 as the child grows. Early walkers also may walk with a wide stance and hold their arms up for balance. As the child gains better balance and masters walking, their legs will typically center under their body, and they will lower their arms to their sides. Variations in balance, foot placement, and leg positions are expected in all children early on.

Early walkers fall an average of 17 times in an hour. It typically takes two months to see a smooth walking pattern in a new walker. An experienced walker can take more steps, cover longer distances, and falls less often. Heel-to-toe walking patterns are not expected until the child is closer to 5-7 years old.

Gait deviations may lead to problems such as:

• Structural (bone) changes in leg, foot, or spine alignment
• Pain
• Frequent falls
• Decreased functional mobility (the ability to move around one’s environment and do everyday tasks)
• Poor endurance or activity fatigue (tiredness or exhaustion that occurs after physical activity as compared with their peers)
• Difficulty with skills, such as running, jumping, hopping, skipping, and galloping
• Difficulty when walking longer distances or on uneven surfaces

It is important to mention any concerns you have about your child’s walking pattern to their pediatrician or a physical therapist. Ask for an assessment of your child’s walking pattern if they are:

• Not walking without holding on to anyone or anything by 18 months.
• Refusing to put weight on one or both of their legs (limping).
• Turning their toes inward (in-toeing) or outward (out-toeing) when they walk.
• Walking on their tiptoes more than half the time (toe walking).
• Walking in a crouched position, always keeping their hips and knees bent.
• Falling more often than average for a new walker without the ability to catch or protect themselves.
• Rolling in at the ankles (overpronation).

Signs and Symptoms

There are many different types of gait deviations and many different causes. They are named for the visual signs that are seen in specific walking patterns. Gait deviations that are often seen in children include:

In-toeing. Toes that point inward, toward each other (which may appear like “pigeon toes”) may be caused by one or a combination of the following conditions:

• Metatarsus adductus. The front part of the foot (from the middle to the toes) curves inward.
• Internal tibial torsion. This is often caused by the baby’s position in the womb, leading to an inward twisting of the shin bone (tibia), and the appearance of “bowed” legs.
• Femoral anteversion. This describes a twisting of the large bone in your thigh (femur).

Out-toeing. Toes that point outward away from each other may be caused by one or a combination of the following conditions:

• Overpronation. Some pronation is normal for shock absorption during walking. Excessive pronation causes the arch to flatten (collapse) more than normal and is called overpronation.
• External tibial torsion. This describes an outward twisting of the shin bone (tibia), which may appear as “knocked knees.”

Limping. Sudden limping (uneven walking in which the child favors one side) may be caused by pain, minor injury, or a broken bone. In rare cases, a joint infection or tumor can cause limping.

Toe walking. This walking pattern may be present as a child is learning to walk and exploring their environment. It is considered a gait deviation when it persists past 2 years of age. When it occurs more than half of the time a child is walking, it may interfere with the development of balance and movement skills. If your child is toe walking on one leg only, this may indicate a more serious condition or difference in leg length. Learn more in the Physical Therapy Guide to Toe Walking.

Crouch gait. This walking pattern describes when a child maintains hip and knee flexion (bending of the hip and knee joints) throughout their walking, never fully straightening their legs.

Delayed walking. When a child is not walking on their own (without holding on to anyone or anything) by the age of 18 months, they are considered a delayed walker. One in 6 children has a delay in achieving independent walking.

Talk to your child’s pediatrician or physical therapist if you notice your child has a walking pattern that is different from their peers.

How Is It Diagnosed?

A gait deviation may be diagnosed by a physical therapist observing the child walk. Children may be referred to a doctor prior to being referred to a physical therapist (such as an orthopedist or neurologist), and, in some cases, your child might have additional tests like an x-ray, MRI, or CT scan ordered by the doctor.

Your physical therapist will perform a complete evaluation to assess your child and determine any factors that may contribute to their walking pattern. They will start by gathering information about your child’s health history. They may ask you questions such as:

• Tell me about your pregnancy and delivery.
• When did your child start walking? When did they meet other motor milestones like sitting, crawling, and pulling up?
• Do you see this walking pattern all the time? And if not, what percentage of the time?
• Does your child fall a lot? How often does your child fall?
• Does your child’s walking pattern change throughout the day or with activities?
• Does your child complain about pain?

Your physical therapist also will conduct a physical exam. This may include:

• Examining trunk and leg alignment in different positions like standing and lying down.
• Measuring leg lengths.
• Measuring movement, or range of motion, in the joints to assess how hips, knees, and ankles are moving.
• Testing or observing strength during movements like squatting or going up and down the stairs.
• Watching the child walk with and without shoes on.
• Assessing your child’s functional skills for participation and play activities, such as balance, climbing, and running.

If a diagnosis cannot be made with movement observations and physical examination in the clinic, a referral for more specialized testing, like instrumented gait analysis using 3D motion capture and electromyography, or EMG, may be recommended.

How Can a Physical Therapist Help?

Your physical therapist will use the best available evidence to develop a treatment program for your child’s specific needs, challenges, and goals. The treatment plan will be based on your child’s specific gait deviation, age, and severity of the deviation. They will work with you to improve your child’s walking pattern by:

• Strengthening weak muscles.
• Stretching tight muscles or joints.
• Promoting the development of gross motor skills.
• Improving balance.
• Supporting the development of bones and their alignment.

Your physical therapy program may include:

• Stretching and strengthening exercises. Your child’s physical therapist will choose the right exercises to address your child’s specific needs. They also will teach you how to help your child perform these exercises in between therapy sessions at home.
• Manual (hands-on) therapy. Your child’s physical therapist may use their hands to apply gentle pressure to increase movement and address any underlying restrictions in the joints and muscles.
• Balance training. Your child’s physical therapist will select a series of exercises specifically designed to improve your child’s stability and control while standing and walking to help improve walking patterns and reduce falling.
• Gait and mobility training. Your child’s physical therapist will also focus your child’s exercises that enhance their overall mobility, targeting strength and coordination of the lower body.
• Patient and family education. Your child’s physical therapist will educate you about proper supportive footwear and best practices for your child’s postures, positions, and activities to support their walking.
• Taping techniques. Your child’s physical therapist may apply adhesive therapy tape to certain muscles and joints to improve muscle function, reduce pain, and help your child achieve proper leg and foot alignment. These techniques can provide feedback to your child and support muscle activation to improve their walking ability.
• Electrical stimulation. Your child’s physical therapist may use gentle, targeted electrical impulses to trigger specific nerves and cause muscle contractions at precise moments during their walking. This is called functional electrical stimulation. This may help to correct certain walking patterns and help your child walk in a more coordinated fashion.

Your physical therapist also will partner with other members of your health care team to address any other identified movement problems. If needed, they also can recommend:

• Bracing or orthotics
• Serial casting
• Functional electrical stimulation, if the physical therapist does not provide this treatment

If Surgery Is Needed

If surgery is needed, your child will likely be evaluated by an orthopedic, or bone, surgeon. Surgeries may be performed to correct some causes of the gait deviations discussed in this article. If your child needs surgery, it is important for them to participate in physical therapy both before and after surgery to help strengthen the body for a better and faster recovery.

Can This Injury or Condition Be Prevented?

Gait deviations cannot typically be prevented. However, it is important to have gait deviations assessed early to rule out certain movement disorders or other developmental conditions. Treating these gait deviations early can help ensure healthy growth of your child’s bones, including their foot and ankle structures.

Developmental monitoring and screening are the keys to diagnosing developmental delays quickly. Monitoring is ongoing and the responsibility of all the child’s caregivers. Screening is conducted by a professional and may include health care workers or individuals trained to work in community or school settings. It should occur at a child’s nine-, 18-, and 30-month well-child doctor visits.

Shoes also affect walking patterns. Shoes affect how the foot touches the ground with each step. Shoes also change how the bones and the muscles of the foot work during walking. Gait deviations may result from shoes that are too small, too large, too heavy, or too stiff.

When children are first learning to walk, it is recommended they:

• Are barefoot or wear a light, flexible sole shoe.
• Gain experience on a variety of surfaces (carpet, hard floors like tile or wood, grass, or sand).
• Have lots of practice opportunities throughout each.

What Kind of Physical Therapist Do I Need?

All physical therapists are trained through education and experience to evaluate, manage, and treat various symptoms and conditions. You may want to consider seeing a physical therapist who is:

• Experienced in treating pediatric patients.
• A board-certified clinical specialist in pediatric physical therapy, or who has completed a residency or fellowship in pediatrics. This physical therapist has advanced knowledge, experience, and skills that may apply to your child’s condition.
• A physical therapy practice that focuses on pediatric orthopedics or pediatric gait deviations.

You can find physical therapists in your area with these credentials and clinical expertise through Find a PT, a tool built by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapist's experience treating pediatric gait deviations before you make an appointment.
• Be prepared to describe your symptoms in as much detail as possible, and note what makes them worse or better.

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Further Reading

American Academy of Pediatrics. What to look for tool. Does my child have physical developmental delays? Accessed June 30, 2025. https://www.healthychildren.org/English/MotorDelay/Pages/default.aspx .

Centers for Disease Control and Prevention. Learn the signs. Act early. Accessed June 30, 2025. https://www.cdc.gov/ncbddd/actearly/index.html.

WHO Multicentre Growth Reference Study Group, de Onis, M. (2006). WHO motor development study: Windows of achievement for six gross motor development milestones. Acta Paediatr Suppl. 2006;450:86–95. https://pubmed.ncbi.nlm.nih.gov/16817682/

The Academy of Pediatric Physical Therapy contributed to this consumer resource. It is for informational purposes only and is not intended to represent the position of APTA Pediatrics.