Patients with bladder exstrophy demonstrate pubic diastasis with external rotation of the ilia and posterolateral orientation of the acetabula. Iliac osteotomy is performed to approximate the pubis and thus facilitate the genitourinary repair. The role of iliac osteotomy in the correction of gait abnormalities is controversial. Our goals in this study were to define the presence of hip pathology and gait abnormalities in patients treated for bladder exstrophy and to evaluate the effect of iliac osteotomy. We reviewed pelvic radiographs and gait studies in 15 children. The treatment included bilateral iliac osteotomy in nine of 15 of these patients. We found minor hip dysplasia in two patients, but we saw no evidence of subluxation or dislocation. Pubic diastasis increased with age and was not related to osteotomy. Patients had slightly less passive hip internal rotation than age-matched controls. There was no correlation between the restriction of hip internal rotation and the amount of pubic diastasis. Two thirds (10 of 15) of the patients exhibited increased lower extremity external rotation during gait. None of the subjects demonstrated a waddling gait (gluteus medius lurch) described in the literature. Based on our results, iliac osteotomy does not affect gait patterns in children with bladder exstrophy. However, we believe that it is indicated to improve the results of genitourinary repair.