Findings That Are a Normal Part of Development

Many findings that worry families are in fact natural stages of growth and settle on their own with time:

• In-toeing in infancy: common in children who have just started walking
• Leg alignment changing with age: a mild bow-legged appearance at a young age, then a mild knock-kneed appearance and subsequent correction, are normal developmental stages
• Flexible flatfoot: if the arch appears when the child rises onto tiptoe and there is no pain, treatment is generally not needed
• Occasional toe walking

Observation is the priority with these findings. However, assessment is needed if they are one-sided, progressive, painful or limiting function.

Situations Requiring Assessment

• Developmental dysplasia of the hip — asymmetry when the legs open, crease differences, limping
• Scoliosis — shoulder and waist asymmetry, one side of the back rising on bending forwards
• One-sided or progressive leg alignment problems
• Persistent toe walking
• Pain at a single point that wakes the child at night
• Limping — particularly if accompanied by fever
• Injuries that may involve the growth plate

How Children’s Fractures Differ

A child’s bone is different from an adult’s: it is more flexible, unites faster and contains a growth plate (physis). These three features directly affect the treatment decision.

• Some fractures in children are bending injuries that do not break the bone completely; they can be missed on X-ray
• A degree of displacement can correct itself during growth, so not every displacement needs surgery
• Fractures involving the growth plate are handled differently; follow-up is recommended because they can leave differences in length and alignment in the long term
• Some injuries thought to be “sprains” are in fact growth plate injuries

The Young Athlete and Overuse

Intensive, year-round training in a single sport increases the risk of overuse injuries in a growing child. Pain at the front of the knee and behind the heel is common in this period.

• Increase training load gradually; avoid sudden jumps
• Plan variety of sport and periods of rest across the year
• Make sure the child and the coach know not to train through pain
• Review sleep and nutrition

Advice for Families

• Do not swaddle your baby tightly; the hips should be able to bend and open freely
• Choose flexible-soled shoes that do not squeeze the foot; “corrective shoes” are not needed if there is no pain
• Watch your child’s gait from behind and in front from time to time
• If there is rapid growth in adolescence, check for asymmetry of the back
• Always tell your physician if there is a family history of hip dysplasia or scoliosis

When Should You Seek Assessment?

• If there is limping (particularly with fever)
• If leg alignment is one-sided or getting worse
• If you notice asymmetry of the shoulders, shoulder blades or waist
• If there is persistent pain at a single point that wakes the child at night
• If the child is not using a limb after an injury

When to Seek Medical Help Without Delay

• Limping or refusing to use a limb together with fever (suspected joint or bone infection)
• Obvious deformity or inability to bear weight after an injury
• Coldness, pallor, loss of sensation or absence of a pulse in the limb
• Increasing pain, distress and tense swelling within a cast
• Loss of strength in the legs, disturbance of walking or a change in bladder or bowel control

These findings require urgent assessment. Outside office hours, go to the nearest emergency department.

Frequently Asked Questions

My child has flat feet — is treatment needed?

Flexible flatfoot that causes no pain and does not impair function usually needs no treatment; if the arch appears when the child rises onto tiptoe, the structure is flexible. Assessment is recommended if there is pain, early fatigue or a rigid flatfoot.

My child in-toes — should I buy corrective shoes?

In-toeing is common in children who have just started walking and usually corrects with growth. There is no reliable evidence that corrective shoes and insoles change this. Assessment is needed where it is one-sided or progressive.

Are growing pains a real thing?

Leg pains in children that typically occur in the evening and at night, affect both sides and disappear by morning are described. However, one-sided pain, pain at a single point, or pain with limping or fever does not fit this description and requires assessment.

Does a heavy school bag cause scoliosis?

No. A heavy bag can cause back pain but is not the cause of idiopathic scoliosis. Scoliosis is a structural curvature and does not develop from postural habits.

Will my child’s fracture need surgery?

A child’s bone unites quickly and a degree of displacement can correct with growth, so many fractures are treated in a cast. Surgery may be considered for fractures involving the growth plate, extending into a joint, or with marked displacement.

My child trains intensively in one sport — is that a problem?

Year-round intensive training in a single sport increases the risk of overuse injury during growth. Variety of sport, graded increases in load and periods of rest are recommended.

Academic Work

Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of paediatric orthopaedics and growth-related deformity and related areas. The publication list and verifiable academic sources are available on the Publications page.

Related Pages

• Developmental Dysplasia of the Hip (DDH)
• Scoliosis (Curvature of the Spine)
• Overuse Injuries and Tendinopathies
• Trauma and Fracture Care
• Conditions

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The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.

Last updated: 8 August 2026

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