Gait disturbances are one of the most common concerns of parents. Children may begin walking with their feet turned in or out, leaving parents with many questions. The problem may be coming from anywhere between the foot and hip. Some deformities occur at one level (i.e. foot, leg, knee, or hip), while others are more complex. Some children may "grow out of it", while others will not.

• Genetic: Rotational problems often run in families. When parents and siblings have grown out of it, the presenting patient/child usually will as well.
• Intrauterine position during pregnancy may cause the foot to turn in.
• Sleeping or sitting postures may not cause the problem, but will delay the resolution of them.
• Compensating mechanisms for limb deformities.
• Tight muscles and ligaments at any level.
• Bone deformities in the hip, knee, tibia, or feet.

• Observation of the child at rest, standing, walking and running.
• Checking hip range of motion.
• Checking knee structure and the rotation of the leg bone on the thigh bone.
• Checking the position of the ankle and the leg bone to determine bone deformities.
• Observation of foot posture to check for curvatures and elevation of the arch.
• Neurological problems must be ruled out.

• To effectively treat rotational problems, the level and severity of the deformity must be determined.
• If sleeping position and sitting position habits perpetuate the deformity, they must be changed.
• There may be a need for serial casting (every 2 weeks) with plaster or fiberglass to put tight ligaments and muscles into a continuous stretch. This may be necessary for anywhere between 2 and 8 weeks.
• In shoe custom molded orthotics or gait plates to help encourage normal walking.
• In rare cases, surgery may be necessary if the problems persists and walking becomes difficult or if the child continues to fall or trip.
• Braces for the legs are rarely needed.
• In some cases, continued observation of the child may be all that is necessary. A foot and ankle specialist (Podiatrist), who sees these problems all of the time, should be consulted to alleviate parental fears.