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In-toeing and Out-toeing in Toddlers

Although we all want our children to be perfect in every way you should know that having a gait abnormality is very common in many children. More often than not these abnormalities will work themselves out over time, but we understand that you may have some questions and concerns regarding two commonly seen gait abnormalities: in-toeing and out-toeing.

Why Do My Child’s Feet Point Inward?

If your child’s toes point towards each other when they walk it’s known as “in-toeing” or “pigeon toes”. There are three main reasons that this could occur: having curved feet (metatarsus adductus), having a twisted shin bone (tibial torsion), or having a twisted thigh bone (femoral anteversion). These conditions are genetic and are difficult to prevent because they occur in utero. The type of treatment considered depends on the reason for your child’s in-toeing.

  • Metatarsus adductus: This means that your child’s feet curve in the middle. Their foot may resemble a club, but this should not be confused with clubfoot deformity. This condition will usually spontaneously resolve itself before your child even begins walking (by 4-6 months). However, if it doesn’t then casting has been proven to work on children of around 9 months.
  • Tibial torsion: Sometimes the shin bone can become twisted in the birth canal to fit the baby. You won’t even know this has happened until you see your child walking and their toes point inward. This will usually correct itself without intervention before they become school-aged. Unfortunately, casting and special shoes will not work as treatment. In rare cases surgery may be used to fix the problem.
  • Femoral anteversion: This is when the thigh bone is twisted resulting in turned in knees and toes. Special shoes and braces do not help, but in severe cases where the child is tripping a lot when walking or in pain surgery may be required. This is not usually even considered an option until around 10 years old.

Out-toeing, Is It Normal?

Out-toeing is far less common than in-toeing, but it is still not usually a cause for concern. There are four main causes leading to out-toeing: flatfeet, outward twisting of the leg (external tibial torsion), hips turned out (hip contracture), and a thigh bone that is angled backwards relative to the hip joint (femoral retroversion). Treatment is, again, dependent on the cause of your child’s out-toeing.

  • Flatfeet: When the out-toeing is due to having a lack of arches there is usually no pain associated and treatment is not administered.
  • External tibial torsion: This condition is usually see your child develop later in life and will usually only affect one leg instead of both. It can cause pain in the knee area, but will usually fix itself.
  • Hip contracture: When a child is born with tight hips it is because of the position they were in while in the uterus. Tightness in the hips will usually sort itself out, but there is no age limit on this. Each child is different.
  • Femoral retroversion: Although far less common that femoral anteversion, it can occur in children, especially those who are obese. Since the thigh bone is angled backwards it can cause the entire leg to turn outward. Additional problems that can occur with this condition include early arthritis and other hip problems. Treatment for this problem will usually involve surgery.

When to Seek Medical Attention

If your child has a gait abnormality we understand that you want to make sure everything is developing correctly. Don’t hesitate to call Dr. Peyman Elison and Dr. Viedra Elison at (623) 584-5556 to schedule an appointment with us at Fixing Feet Institute in Surprise, AZ.


Dr. Peyman A. Elison
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Founder and Managing Partner of Fixing Feet Institute