Pediatric In-Toeing & Out-Toeing Specialist

What are in-toeing and out-toeing?

Most adults’ feet point straight forward or slightly outward.  In infants and children, In-toeing is common and generally noted by an inward rotated foot or feet when walking or running.  If your child in-toes, she or he will most likely outgrow this condition naturally without intervention by age two.  Out-toeing is just the opposite with an outward rotation of the foot or feet.  Out-toeing is not as common as in-toeing, but in most cases, will also resolve naturally as the child develops. 

What causes in-toeing and out-toeing?

• Femoral Torsion: The femur (thighbone) is rotated inward so that the child stands with both the knees and toes pointed inward.  Surgery should only be considered if your child is 8-10 years old and this condition continues to cause significant walking difficulties.
• Tibial Torsion: The tibia (lower leg) is rotated inward while the knees point forward.  Surgery should only be considered if your child is older than 9 years old and has an abnormal gait with constant tripping.
• Metatarsus Adductus: The foot in is rotated and curved inward like a kidney bean.  The foot is very flexible and can be straightened by gently pushing it in the opposite direction.  When this condition is severe in babies aged 6-9 months, serial casts or special corrective shoes are applied with a high rate of success.  

Should I be worried about my child's in-toeing?

No. In most cases, alignment conditions in children such as outward bowing of the legs or inward positioning of the knees also known as knock knees, are normal and will resolve in time as your child develops without casts, braces, or surgery.  Flat feet, for instance, are also common in infants and young children and this will change as the arch begins to develop in your child’s foot by the age of 5.

How are in-toeing and out-toeing diagnosed?

If you want reassurance that your child is walking normally, visit Gotham Footcare and your doctor will perform a thorough physical examination with gait assessment and x-rays on your child.

How are in-toeing and out-toeing treated?

In general, treatment is not necessary as the common causes listed above are normal variations in your growing child.

Orthotics can be made for your child to assist your child with walking and running, however, they are not necessary since rotation in your child’s bones usually improves over a period of time as the child grows and develops.  Children with in-toeing or out-toeing may present some early challenges for you and your child, but you can expect your child to live a normal, active, and healthy life without any limitations in your child’s activities from simple outdoor games to competitive sports.  If a functional problem exists and your child is unable to walk or run effectively visit Gotham Footcare.