Flat Feet, In-Toeing and W-Sitting in Children

Children's legs and feet change shape a lot as they grow. Many patterns that worry parents, like flat feet, in-toeing and bow legs, are normal stages of development that improve on their own. Here's how to tell what's normal and what needs checking.

Flat feet

Most babies and toddlers look flat-footed. A fat pad hides the arch, and the arch gradually develops through childhood.

Usually normal:

• Flexible flat feet: the arch appears when the child stands on tiptoes or when the big toe is lifted
• No pain, and the child is active and keeps up with peers

Worth checking:

• Pain in the feet or legs
• Stiff, rigid flat feet (no arch on tiptoe)
• Only one foot affected
• Frequent tripping or reluctance to walk or play

In-toeing (pigeon toes)

Feet turning inwards when walking is common in toddlers and young children. It can come from the foot, shin bone or thigh bone.

Most in-toeing improves on its own as the child grows, often by around age 8 to 10.

Worth checking: if it's getting worse, only on one side, causing frequent falls, causing pain, or persisting past around age 8 to 10.

Bow legs and knock knees

• Bow legs are normal in babies and toddlers and usually straighten by about age 2.
• Knock knees are common between ages 3 and 6, then usually improve.

Worth checking: if they're severe, only on one side, getting worse, or outside these typical ages.

W-sitting

W-sitting is when a child sits with their bottom on the floor and their legs turned out to each side, making a W shape. Many children sit this way at times and it isn't harmful in itself.

Worth checking if your child sits only this way and can't sit comfortably in other positions, as this can sometimes be linked to low muscle tone, weak core strength or tight hips. Encourage a variety of positions: cross-legged, side-sitting and long-sitting.

Toe walking

Walking on tiptoes is common in toddlers learning to walk. If it continues most of the time after about age 3, or the child can't stand with heels flat, it's worth an assessment.

How physiotherapy helps

A physiotherapist can assess walking, flexibility, strength and development, reassure you if it's normal, and give targeted exercises and activities when needed.