15 MO DD sticking one foot out to side when walking - is this normal?

[twinmam]

DD1 is just learning to walk (still holding on to my finger and refusing to let go!) I've noticed that she sticks her left foot out to the left at about 45 degrees. Her right foot points forward and DD2 points both her feet forward. Any suggestions on what this could be and if I need to do anything? If it makes any difference, she was 6 weeks prem and a breech baby - but then so was her sister!

[Jacksmama]

Hi twinmam - thumbwitch saw your post and asked if I'd have a look because she has this idea that I know what I'm talking about .

I am a chiropractor (in Canada, though so, sadly, not much hands-on use to you) and I see quite a few mums and babies in my practice. IMHO, most babies do funny things with their legs when they're learning to walk. Sort of the gamut from what you're describing, to walking on tippy-toes for a few weeks, to waddling like penguins. In just about all cases I've seen, they stop doing whatever it is when they get to be comfortable walking and are solid on their feet. So if I were seeing her professionally, there are a few things I would check, but otherwise I'd let her get on with it and observe for a few weeks to see if she stops on her own once she's willing to let go of your hand.

What's worth checking out is whether everything's ok with her hips. When a foot is seen to turn out, the problem is most often not actually the foot (which is the end of the line, so to speak) but the hip, where the entire leg starts, IYSWIM. What you can do when you next change her nappy is

1 - lie her on her side and sort of poke around in the outside-to-middle of the left buttock/ hip and see if the muscles seem very tight to you. Check the other side to compare. This can be a bit difficult with a squirming toddler of course and even more if you're not used to feeling and noticing muscle tightness and texture. But - if you really feel a difference in muscle tension between the left and the right, that may be what's causing the leg/ foot to turn out. The muscle group in that area is called the "external rotators" and they turn the leg out (especially a muscle called the piriformis) and when they're abnormally tight, they keep the leg in a turned-out position. Treatment would be massage or myofascial release (a deep form of massage) of those muscles - best done by a massage therapist, physiotherapist or chiropractor who specializes in Active Release Technique. To find a chiro who does A.R.T. in your area, go to Active Release.com and click on "Find A Provider". I don't know if you're anywhere near Bournemouth, but you could also ring Anglo-European Chiropractic College and ask for a recommendation for practitioners in your area who specialize in treating toddlers.

2 - if the above seems ok to you, and she's walking cofidently but still turns her foot out, I'd take her to an orthopedist to have the foot/ ankle structure checked out, or the hip joint. Babies can have something called "developmental dysplasia of the hip" where the hip socket and head of the thigh bone don't form correctly. Usually diagnosed by x-ray.

It's likely to be something she'll outgrow, though, so for now, don't stress too much.

Hope this helps.

[twinmam]

Oh bless you Jacksmama and Thumbwitch As the babies were breech they had a scan when they were a few weeks old and various dr's and health visitors have done hip checks - I think exactly the one you mentioned. I must admit I did have a worry in the back of my mind tho that this might be hip-related and just showing itself now she is walking. I will try the hip thing myself and see what happens! Am thinking any problems with her hips would have been diagnosed by now tho with all the checks that have been done? Thanks so much for taking the time to reassure me - it has helped and hopefully it will just correct itself but in the mean time I'll keep an eye on it!

[Elibean]

dd2 did exactly this, both feet but one much more than other. She was breech (well, transeverse to be exact) so had scan, but not follow-up one later on..we were referred for scan to be sure, but it was absolutely fine.

She's outgrown a lot of it, but still has one foot that turns a bit and may need supports inside her shoes later on - the physio said meantime they do nothing, watch and wait and see if they're still needed at school age.

HTH

[Jacksmama]

Just one thing, twinmam, when medical doctors rule out problems with hips and hip joints what most of them are looking at is the bones. Medical doctors, in my humble opinion, seem, for the most part, blind to soft tissue problems. Or maybe that's just here. I've treated lots of patients who were told that they had this, that, and the other wrong with them, who returned to their medical doctors very much improved because I did soft tissue work as well as joint manipulation, and their doctors were astonished that "a little massage" could do so much. Well, it's a lot more than "a little massage" (not nearly as relaxing, for one )... but anyway - that's why I brought up that tightness in the hip muscles and the joint capsule (not the joint itself) can be the culprit.

I like the "watchful waiting" approach myself (unless it's a soft tissue problem, then it's "treat, watch and wait".)

[cory]

Jacksmama is so right. This is how a paediatric consultant came to miss my dd's pretty bloody obvious hypermobility: he thought he had done everything needed once he had X-rayed her ankles. But of course, soft tissue problems don't show up in X-ray.

[twinmam]

Cory - how terrible. Kind of makes you lose faith in the medical profession at times I bet. Am thinking the scan DD had when a few months old would have highlighted any soft tissue problems? Is that right? We've also had hip checks done by health visitors and consultants at various points... Still, something is niggling about the way she walks. Am going to try what Jacksmama suggested re. 'testing' her hips when DH is around tomorrow (I did start to have a go today but DD2 was too interested in what was going on and was trying to help!)

[Jacksmama]

Twinmam, if something niggles you about her walk, get it checked out. What kind of scan did she have at a few months old? If x-ray, then, no, soft tissue problems would not have been spotted. If ultrasound, maybe... but not if this is a problem that has developed since her birth, instead of something she was born with.

A simple x-ray of the hip will reveal whether she has dysplasia of the hip. Ditto foot and ankle x-rays - they will show structural abnormalities and those are the first things that need to be ruled out. If they're normal, then you're dealing with a soft tissue problem and can go from there.

[twinmam]

Thanks Jacksmama. It was an ultrasound I think... def not an x-ray. I will do hip thing tomorrow with DH and we will take it from there and watch it closely over the next month I think. If it's still happening I think I will go to the GP and ask to be referred. Thanks for your help; really really useful and also reassuring.

[Jacksmama]

You're most welcome. Let me know how you get on. If you have any other questions or concerns I am a regular in the One-Child Tea Room. We're currently on the 8th Tea Room thread, they're numbered consecutively. But anyone is welcome regardless of the number of children, so feel free to visit. There's booze and eye candy...

[twinmam]

Sounds like just my kind of place - tho thought I might not be welcome for two very obvious reasons Will def call in

[Jacksmama]

No no no - everyone is welcome!! Most of us have one child, for various reasons, but two are pregnant, and one has a couple... it doesn't matter at all! We're all just a bit loony though...

[cory]

twinmam on Fri 22-May-09 20:22:34
"Am thinking the scan DD had when a few months old would have highlighted any soft tissue problems? Is that right?"

not necessarily, I don't think

dd's had MRIs later and they only show up if anything is actually lying wrong at that particular moment

the thing with soft tissue disorder is that your joints aren't stable, so they can look beautifully straight in a scan and then go flying when you try to put weight on them

afaik soft tissue looks the same whether it is lax or not

[twinmam]

Thanks Jacksmama - was only planning on one anyway but ended up with two for the price of one Will def pay you a visit!

Cory - thanks for that. It is definitely worth knowing and worth me keeping an eye on things and persisting if I still feel something is not quite right.

[Jacksmama]

Then you definitely qualify

[bethylou]

Hi, We had this same problem with our DS. He only kicked right leg at birth; commando crawled with right leg only for a month; cruised only going right and could only walk holding our right hand (ie to support his left side). He also bounced crooked in bouncer and walked crooked in walker! It took me till he was 11 months to tie it all up in my head and start to worry! We took him to the doc who checked hips (fine) and then went to a chiropractor working with kids. Turned out DS had a (soft tissue) constriction in his neck and in his pelvis. Chiropractor did some very gentle releases and it made a fairly immediate improvement. DS also started walking at the same time so hard to know how much was influence of chiropractor and how much was coincidence of walking. Both feet now go in the same direction and I think it was money well spent!! Maybe I was just a neurotic mother?!

[Sycamoretreeisvile]

OP, my DD had this issue and we took her to a specialist at C&W hospital. She has hypermobility. Nothing much to be done, but we are doing what we can to strengthen ligaments. Keeping her active, encouraging climbing - ballet etc for core strength.

DD is 3.9 now. She used to fall over A LOT - does your DD? She would trip over her feet as when she ran they would literally fall directly in front of the opposite foot.

(almost opposite to your DD, but she can equally turn her feet massively outwards. She can bend double, but her feet behind her head etc. Quite the yoga bunny

[twinmam]

Thanks bethylou8 and Sycamore*. I don't think it is anywhere near as pronounced as your DS bethylou - she doesn't seem to favour one leg more or anything like that.

Sycamore - it's difficult to tell if she falls over a lot as she's not yet walking apart from round the furniture or holding my finger. If pushed I would say she falls over slighlty more frequently than her twin sister who is at the same stage with walking (but minus the sticking out foot). The thing that first alerted me to her sticking out foot was that I kept on standing on her foot when walking behind her, hanging onto her hands I then realised her foot was sticking out.

What exactly is hypermobility - I get the gist of it from you post and cory has referred to it but not entirely sure what it entails?

Am going to ask HV to come and have a look at DD although I think until she starts walking on her own it's going to be hard to determine whether this is just her way of learning to walk or something more worrying.

[Sycamoretreeisvile]

It's nothing really serious twinmam, so no need to worry really. In some cases (one on a thread the other day) it can cause pain in joints for kids - but that was a child whose knees were so hypermobile they kind of pushed back then the boy stood for any long period of time .

With DD it really just means super flexible. At a young age, because ligaments (the "strings" that hold you muscles and bones together - sorry if you know all this, just making sure answer is clear) are less taut than they should be.

With age and with exercise the do tighten up. But I used to imagine DD like a bit of a raggy doll really. Where others ran, she would flail, bless her. I used to hold my heart in my mouth when she ran. I really would not allow myself to stop her, even though she took some bad tumbles, because I didn't want her to be a cautious kid. It was hard though. It's only now that I've really started to relax about her physically. She's much stronger now.

Not that 15 months is late AT ALL, both mine were 14 months when they walked - one is hyperm - the other not. Sound like your DD is getting there with her walking - but if this milestone is delayed it can be to do with HM...

I've rambled, but hopefully have answered your question!

[twinmam]

Ah - now this is making sense as a few years ago I snapped two ligaments in my knee and after ops etc I can remember the consultant comparing my damaged knee to my not-damaged knee, bending them around all over and then saying something like 'You're hypermobile in both knees'. He might have said double-jointed? So am thinking that IF DD is hypermobile she couldve got dodgy ligaments from me and that would explain the foot sticking out as opposed to the potential hip problems which would (probably) have shown up on the scans and tests and things. Thanks Sycamore!Am assuming this is the sort of thing you go to the health visitor/ GP with? Or would I just be better bypassing them and seeing someone like Jacksmama? Nearly 16 months FEELS very late to walk - am sick of lugging my 2 heavy little wriggly lumps around everywhere I know they'll get there though!

[Sycamoretreeisvile]

Hi Twinmam - it is usually heridtary (sp?) as I am also hypermobile (at least in my youth!). I still cruckle over on my ankle from time to time - my dad used to have that issue too. So yes, she probably got it from your side of the family.

I went to my GP and got a referral, so maybe that root? If you're not satisfied may then pay for someone like Jacksmama (assume you would have to pay?)

[bethylou]

I am also hypermobile - knees and pelvis - so I guess DS gets it from me too (partly why I was keen to get some answers early on as I was awre of it) One thing I've had difficulty with is very tight muscles which try and compensate for hypermobile joints and then tear unusually easily (e.g. one of my stomach muscles tore 3 weeks before I gave birth which none of the health professionals have ever heard of!) I think I'm an unusual case so don't think others need to worry! (Seriously considering donating body to medical science when I die..!!)