In-Toeing and Out-Toeing in Toddlers

Understanding In-Toeing and Out-Toeing in Children

When your child is learning to walk, all attention turns to their first toddling steps – and many more beyond that! 

But while most feet point straight ahead or slightly outward as they walk, you might start to notice your child’s feet point inward (in-toeing) or significantly outward (out-toeing) instead. You might hear some people refer to these conditions as being “pigeon-toed” or having “duck feet.”

In-toeing and out-toeing are relatively common sights in developing toddlers. We highly recommend keeping a professional eye on your child if they have one of these conditions, but the good news is that direct intervention is often not required.

What Are In-toeing and Out-toeing? What Causes Them?

When in-toeing or out-toeing is present, it typically means that part of a child’s skeletal structure is twisted or rotated in some way. 

In the case of in-toeing in toddlers, there are several common causes:

  • The thighbone is rotated inward, also known as femoral torsion or femoral anteversion.
  • The shinbone is rotated inward, also known as tibial torsion.
  • The forefoot is curved inward, also known as metatarsus adductus.

As you might expect, for an out-toeing child, the shinbone or thighbone tend to be rotated outward instead of inward. The hips might also have been rotated and constrained after birth.

In-toeing occurs in about 1 out of every 500 children; out-toeing is much rarer. Both feet are frequently affected equally, but it is not uncommon to see one foot rotated more than the other.

The exact reasons why in-toeing or out-toeing occur in some children are not fully known. It is suspected that the condition may be inherited, so that if you had one of these gait abnormalities as a toddler, the chances may be higher that your children may have them, too.

It is also suspected that in-toeing or out-toeing may be a consequence of a cramped position in the uterus during pregnancy. However, it’s important to note that, should this be the case, it was unavoidable. There is nothing we currently know that parents can do to prevent the appearance of in-toeing or out-toeing.

What to Do About In-Toeing and Out-Toeing

Although the appearance of in-toeing or out-toeing can be quite concerning, the vast majority of cases will resolve on their own. As a child continues to grow and develop, their bones will likely rotate back to their standard positions over time. Attempts at accelerating this correction, such as bracing or physical therapy, tend not to have much effect.

Furthermore, having either condition rarely tends to serve as any impediment to a child’s comfort or mobility. They can still run and play as normal!

However, as we noted earlier, it is still a very good idea to contact us about your child’s condition. We may recommend periodic evaluations to make sure self-correction is happening as it should, and can take steps as soon as possible to provide support if necessary.

Although uncommon, any instances in which in-toeing or out-toeing is particularly severe or believed to be connected to a child’s discomfort or mobility problems, such as limping or tripping, should receive special attention. Additional action might also be needed if the condition has not resolved itself by a certain age (usually 9 or 10).

When necessary, we might recommend physical therapy, casting, or corrective footwear to treat symptoms, depending on the situation at hand. Surgery is rarely ever needed.

Don’t Worry, But Don’t Ignore

If you have concerns about your child’s feet turning inward or outward as they walk, you can always count on the doctors at Southern California Foot & Ankle Specialists to provide careful diagnosis, compassionate treatment, and peace of mind.

Whether it’s in-toeing, out-toeing, or any other of many pediatric foot conditions, we are here to help. Schedule an appointment at our Ladera Ranch office by calling (949) 364-9255. You can also contact us online if you prefer, and we also have telemedicine appointments available if you prefer to consult with us remotely.

Contact Us

Robert Spencer, DPM

Nitza Rodriguez, DPM

Han Nguyen, DPM

Map & Directions

333 Corporate Drive, Suite 230, Ladera Ranch, CA 92694
Tel: (949) 364-9255 (WALK)
Fax: (949) 364-9250
Office Hours:
Monday - Friday: 9am - 5pm
*(Lunch 12 noon - 1pm)