Common myths in paediatric orthopaedics
Baby walkers, W-sitting, shoes, orthoses, toe walking, growing pains, swimming and scoliosis: what evidence supports and what it does not.
Paediatric orthopaedics is full of rules repeated for decades as if they were proven facts. Some are wrong; others contain a useful idea but become misleading when turned into an absolute rule. These are the ones I would correct first.
A baby walker helps a child learn to walk
No. Mobile baby walkers do not teach walking and create important injury risks. The American Academy of Pediatrics advises against them. A safe floor space, normal play and opportunities to pull to stand are preferable.
W-sitting damages healthy hips
There is no good evidence that occasional W-sitting causes hip deformity in an otherwise healthy child. Forcing every child to avoid the position is not supported. Assessment is more useful when W-sitting accompanies pain, marked asymmetry, motor difficulty or an inability to use other comfortable positions.
Children need structured shoes to form the arch
No universal corrective shoe is required for normal foot development. Before outdoor walking, shoes are not needed to shape the foot; once walking outdoors, their main role is protection. Fit and comfort matter more than labels such as 'orthopaedic' or 'barefoot'.
Every child's flat foot needs an insole
No. Flexible painless flat feet are common in childhood. Orthoses do not have to be prescribed simply because an arch looks low or because the child has reached a particular age. Pain, rigidity, asymmetry and functional limitation change the assessment; orthoses may be considered for symptoms in selected children.
Toe walking is always harmless until age three
Too absolute. Toe walking can occur during early gait development, but persistent toe walking is a diagnosis to assess rather than label by age alone. Unilateral toe walking, loss of previously acquired heel contact, weakness, stiffness or other developmental/neurological features deserve evaluation. Idiopathic toe walking is a diagnosis of exclusion.
Growing pains are caused by bones growing
The name is misleading: their cause is not established and they have not been shown to result directly from bone growth. A typical pattern is intermittent lower-limb pain, often bilateral and in the evening or night, with a normal child between episodes. Persistent focal pain, morning symptoms, swelling, limping, fever or other systemic signs are not typical and need assessment.
Swimming treats scoliosis
No. Swimming is a good sport if the child enjoys it, but it is not a treatment that corrects an idiopathic scoliosis. When treatment is indicated, decisions are based on curve magnitude, growth remaining and progression; sport can accompany care but does not replace it.
A heavy backpack causes scoliosis
There is no evidence that schoolbag weight causes adolescent idiopathic scoliosis. Backpack comfort and unnecessary load are still worth addressing, but spinal asymmetry or persistent back pain should not be explained away by the bag.
The useful rule: look at the child, not the myth
Pain, functional limitation, asymmetry, rigidity, regression or a change from the child's usual pattern matter more than a social-media rule about age, posture, shoes or sport. When one of these is present, an individual assessment is more useful than trying to correct the child at home.
Book a paediatric orthopaedic assessment in MilanSelected sources
- American Academy of Pediatrics — Baby walkers
- Pediatric orthopedic mythbusters — flexible flatfeet, torsion, W-sitting and toe walking
- Idiopathic Toe-Walking — diagnosis, natural history and treatment options
- Growing pains — review and cautionary signs
- Cochrane — foot orthoses for paediatric flat feet
Updated: 17 September 2026.