Group of children standing


Paediatric Physiotherapy Service

Common Concerns

It is quite common for young children to present with normal variations of lower limb development.

Normal variants of the lower limb

It is quite common for young children to present with normal variations of lower limb development. Most of these children will not need to see a physiotherapist and hopefully the information on these pages offers advice and reassurance.


In-toeing, out-toeing, flat feet, bow-legs or knock knees, curling toes or tip toe walking are all seen in the healthy, growing population at certain stages of development and are rarely the sign of anything more.


The resources below will help to explain each of these presentations and guide you as to when to seek medical support:


Child displaying flat feet

Flat Feet


Child displaying intoeing



A child displaying toewalking

Toe Walking


A child running

Development of Normal Walking


A pair of shoes

APCP: Choosing Footwear
for Children


Balance and Coordination

Clinician assisting a child with their balance


Children and young people can experience issues with core stability, balance, and coordination.


Core stability is the ability of the muscles in trunk to assist in maintaining good posture. This includes when producing controlled movements of the arms, legs or the whole body.


Balance is the child’s ability to remain in an upright and stable position during a task. They will need the ability to maintain controlled position during both ‘static’ (staying still) and ‘dynamic’ (moving) activities.


Coordination is the ability of the child to move two or more body parts under control smoothly and effectively.


Children develop their balancing skills between 18 months and 2 years. During this time, your child will start to walk up the stairs while holding on with one hand and run with increased coordination. However, all children are different, and they develop and master the skills they need for building balance and coordination at different rates.



What can YOU do?

Child bouncing on a hopper


Ensure your child engages in as many physical activities as possible. Participation and enjoyment should be the key, not competition. Provide them with plenty of opportunities to practice and learn activities that they find difficult.


Physical play and exercise will help children to develop balance, coordination and strength.


It doesn’t need to be complicated and should be fun. Simply playing in the garden or in a local playground, or taking part in activities such as ball games, skipping rope, or learning to ride a bike are all good examples.


Here is a video we have made to demonstrate a variety of exercises that will help strengthen the core muscles.


Other concerns

Child riding a bike


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