In-Toeing and Out-Toeing in Children

Understanding In-Toeing and Out-Toeing in ChildrenIt’s incredible how fast they grow up. One minute you’re holding your newborn baby in your arms, and the next she’s conquering stairs.

As a parent, it’s natural that you’ll be watching your little one carefully as she progresses from infancy to adulthood, including how she walks and moves. Kids begin standing and walking long before the muscles and bones in their feet and legs have fully developed, and that sometimes means that you may notice some peculiarities in their locomotion. By the time we grow up, most people have feet that point straight ahead or very slightly outward, but children may have feet that point either inward or far apart. This is known as in-toeing (also known as “pigeon toes”) and out-toeing.

Explaining and Describing the Rotation

In-toeing and out-toeing can appear at different stages in your little one’s development. It may affect just one leg, or both at the same time.

In many cases, the condition can be traced to your baby’s position in the womb. As the fetus grows, bones may need to rotate slightly in order to fit the tight space of the uterus. It may take a few years before that rotation fully goes away, but you may not notice it at all until your baby starts walking and the tilting or twisting becomes more obvious. Family history may also play a role in the development of either condition.

Cases may look slightly different or emerge at different times depending on where in the body the twist occurs. For example:

  • Metatarsus adductus, the most common form of intoeing, occurs at the foot and is usually obvious right after birth. In nine out of ten cases, the problem resolves by age 1.
  • If the rotation occurs at the shins, the problem is likely tibial torsion, either internal (in-toeing) or external (out-toeing). Internal tibial torsion usually shows up when the little one begins to walk, while the external version may not be obvious until adolescence.
  • If the rotation occurs at the thighbone (above the knee), it’s probably femoral anteversion (in-toeing) or retroversion (out-toeing). Both tend to be diagnosed at around age 2-3, but while anteversion tends to resolve on its own after age 6-7, surgery is usually recommended for femoral retroversion at younger ages due to higher risks of complication

Should I Be Concerned? What Should I Do?

The good news is that the vast majority of in-toeing and out-toeing cases are considered relatively normal and self-correcting. Usually the condition causes no pain, does not lead to further health or walking problems, will not prevent your child from walking, running, or playing normally, and goes away on its own without treatment as your child continues to grow and strengthen.

However, there are always exceptions. Carefully observe your child as they grow and share any concerns with Dr. Spencer or Dr. Rodriguez. One suggestion is to take pictures of your child standing and walking once every couple of months and comparing the images to see whether the problem is staying the same, getting better, or getting worse.

How Are In-Toeing and Out-Toeing in children Treated?

In most cases, observation is the only recommended treatment, at least at first. Conservative treatments, such as orthotics, bracing, corrective shoes, or physical therapy were once believed to accelerate the correction; more recent studies suggest that for most common causes of in-toeing or out-toeing they do not make much of a difference either way.

That said, if in-toeing or out-toeing is particularly severe, causing pain, impairing the normal development of a healthy walking gait, or has not resolved by a certain age (usually 9 or 10 for most conditions), surgical correction is often recommended to avoid future complications. Such cases are extremely rare, but they do happen.

If you’re concerned about the health of your little’s ones feet or legs, you can always count on Southern California Foot & Ankle Specialists to provide careful diagnosis and compassionate treatment. Whether it’s in-toeing, out-toeing, or a host of other common (and uncommon) pediatric foot conditions, we are Southern California’s experts. To schedule an appointment at our Mission Viejo, CA office, contact us online or call at 949-364-9255.

Contact Us

Robert Spencer, DPM

Nitza Rodriguez, DPM

Map & Directions

27800 Medical Center Road, Suite 110
Mission Viejo, CA 92691
Tel: (949) 364-9255 (WALK)
Fax: (949) 364-9250
Office Hours:
Monday - Thursday: 9am - 5pm
*(Lunch 12 noon - 1pm)
Friday: 9am - 1pm