Sometimes, parents notice something about their child’s legs, hips or the way they walk that doesn’t look quite right – a clicky hip, bow legs, flat feet or a limp. Most of the time, these differences are part of normal growth. Occasionally, they signal an orthopaedic condition that benefits from early review.
This article, based on insights from Dr Claudia Maizen, consultant paediatric orthopaedic surgeon, explains how children’s hips and legs develop, what is normal and when to seek advice.
In babies, the hip joint is still forming. The ‘ball’ at the top of the thigh bone sits in a soft ‘socket’ made mainly of cartilage. If that socket is shallow, the hip may be moving away from the socket – a condition called developmental dysplasia of the hip (DDH).
Early diagnosis makes treatment simpler. A brace or Pavlik harness can hold the hip in the right position so it develops normally. Once a baby is beyond three or four months old, treatment becomes more complex and less reliable.
‘Ultrasound is the most reliable way to diagnose and even predict hip instability in babies. Early treatment can make all the difference.’
– Dr Claudia Maizen
Some differences in babies’ hips are completely harmless, but others warrant a closer look. A light click in the hip joint can be normal, yet a deeper ‘clunk’ that can be felt as the hip moves may indicate dislocation.
Extra skin folds beneath one buttock, a visible leg-length difference or a waddling gait once a child starts walking can also suggest a problem.
Because these signs often overlap with normal variation, expert examination – and, if needed, an ultrasound in young babies or X-ray in children over 6 months – is the best way to confirm whether there is a cause for concern.
All newborns in the UK have a routine hip check soon after birth and again at six weeks. During this assessment, the clinician gently moves each leg to test the stability of the hip joint.
If there’s any uncertainty, an ultrasound scan gives a clear picture of how the ball sits in the socket. For babies under six months, this is the most accurate and comfortable way to confirm that the joint is developing properly.
As babies grow, X-rays become more useful because the bones are easier to see. In older children, assessment also includes examining gait, leg alignment, muscle tone and growth patterns. This helps rule out other causes and pathologies.
The good news is that most conditions affecting children’s hips, legs and feet can be managed without surgery. Treatment aims to guide healthy growth, ease discomfort and prevent problems later in life.
A Pavlik harness can hold the hips in the correct position for several weeks, helping the joint form in a stable way.
In more severe or later‑detected cases, a closed reduction and hip spica cast treatment or surgery may be needed to guide the hip back into place.
These are often physiological – part of normal growth. Children are sometimes bow-legged, typically when they start walking (around age one to two), move into a knock-kneed phase (around four to five) and have straight legs by school age.
Persistent or severe angles, or other symptoms such as short stature or pain, may prompt X-rays or blood tests.
Most children have flat feet until preschool age. If the feet are flexible, painless and arches appear when standing on tiptoe, no treatment is needed.
When the calf muscle (Achilles tendon) is tight, stretching exercises and physiotherapy can help restore flexibility and reduce strain.
This common growth‑related pain happens where the Achilles tendon attaches to the heel bone. It is due to irritation at the growth area in active children during growth spurts. Helpful measures include:
‘Many leg and foot shapes that worry parents are simply part of growth. The key is knowing which patterns are normal and which need review or treatment.’
– Dr Claudia Maizen
If hip or alignment problems are left untreated, they can lead to a lasting limp, leg-length difference or uneven posture. Over time, this can cause strain on the spine and early wear of the hip joint. Fortunately, most of these issues are preventable with early assessment and follow-up.
With timely care, children treated for DDH usually go on to have normal hip function. Growth-related leg and foot differences nearly always straighten out spontaneously during growth, stretching and supportive footwear can be prescribed when needed.
Seek medical advice if your baby’s hip feels stiff, one leg moves less than the other, or your child develops a limp. Sudden limp with hip or knee pain, especially if the joint looks swollen or the child has a fever, needs urgent medical attention.
If you’re concerned about your child’s hips, legs or walking pattern, book a consultation with our paediatric orthopaedic team at OS Clinic.
Prefer to speak first? Call +44 (0)20 7046 8000 to reach our patient liaison team.
It often results from a mix of external and genetic factors and position in the womb (risk factors include packaging disorders, breech birth, high birth weight, positional foot deformities, firstborn, females).
Ultrasound can identify almost all hip pathologies at a young age, including dysplasia and dislocation, while examination alone may miss some cases.
Some mild looseness settles naturally as ligaments tighten, but imaging confirms this safely.
Flat feet before age six and bow legs before age two are usually normal. Persistent or severe and painful cases should be reviewed.
Supportive trainers are usually enough. Insoles and stretching exercises may help if there is pain or muscle tightness.
Daily calf stretches and staying active help prevent tightness during growth spurts.
If corrected early, most children have healthy hips for life. Late or missed cases can increase the risk of later arthritis.
The consultant examines posture, joints and gait, and may arrange imaging or simple movement tests.
This article is for general information only and is not a substitute for professional medical advice. If your child has sudden pain, cannot bear weight or develops a hot, swollen joint with fever, seek urgent medical attention.
Reviewer: Dr Claudia Maizen, children’s orthopaedic consultant
Last reviewed: [18 December 2025]
