Intoeing & Out-Toeing

Intoeing – Learning to Walk with Turned Toes

First steps are an important milestone. They mark a new stage in children’s ability to move and interact with the world around them—and begin the development of mobility that will serve the child for the rest of his or her life. So it is understandable why parents might be concerned when they notice a gait abnormality like intoeing in their baby.

Why Toes Point Inward

Intoeing is a fairly common gait problem in small children. The toes turn inward when your child stands or walks, creating a “pigeon-toed” look. While this usually isn’t harmful, it can concern many families and does need to be monitored. Occasionally, intoeing does cause some issues—your little one can trip on his or her toes, or develop discomfort from pushing off of the wrong part of the foot when walking. Several underlying, congenital issues can cause the toes to turn inward: metatarsus adductus, tibial torsion, and femoral anteversion.

Metatarsus adductus is a curve in the middle of your baby’s foot. This can be a flexibility problem of a rigid deformity, depending on the severity of the issue. Tibial torsion is a natural twist in the lower leg bones, which rotates the foot so it appears to point inward. Usually it’s most noticeable once your child starts walking. Femoral anteversion is excessive rotation in the hip bones that twists the whole leg inward. It’s most apparent around school age.

Growing out of Gait Problems

Any child with intoeing should have their growth monitored by a children’s foot care specialist like Dr. Sanjay Patel. Our team will examine your little one’s feet to make sure that no developmental issues are related to the problem, and that your child isn’t struggling with pain. For most of these issues, the best treatment is waiting to see how they develop.

All of these problems can self-correct as your child grows older. For metatarsus adductus, however, you can take steps to straighten out the feet. Before your child begins walking, the feet are stretched and exercised to strengthen them. If the foot is rigid, the lower limbs may need to be braced or casted into the correct position so that the feet straighten as they grow.

For tibial torsion and femoral anteversion, braces and special shoes are not effective in correcting the twist of the bones. However, bones naturally rotate outward somewhat as they grow; typically this corrects the gait abnormality before the teen years. If the problem persists past ten years old, your child may need surgery to correct it.

Out-Toeing in Children

As any parent is bound to know, a child’s first steps are never perfect. They wobble, they weave, and they ultimately fall over before starting to get the hang of things. Once children get moving at a steadier clip, that walk may still not look exactly as one expects. Several different gait abnormalities may develop, but we will concentrate on the feet turning outward, or out-toeing.

Turned-out Toddling

Out-toeing and its close relative in-toeing are the most common abnormalities in walking that cause parents to consult medical advice. It is a rather obvious condition to spot simply from looking at the way a child walks. It rarely shows any other symptoms, and it rarely causes a child any pain.

In most cases, out-toeing will correct itself naturally as a child’s bones continue to develop. Surgery, custom-made orthotics, braces, and other treatments are typically not needed. The vast majority of children who grows out of out-toeing naturally should have no disadvantages in motion or performance against children who did not grow up with the condition.

Causes of Curving

The most common cause of out-toeing in a young child is a small twist in the bones of the upper or lower legs. The lower leg bone, or tibia, is the most common to blame. If it rotates outward, then a child’s toes will point outward as well.

It is not fully certain why most gait abnormalities of this type develop. A great number of experts believe that one’s family history can play a role. If out-toeing runs among a family line, the odds of a child also having it might be higher. Another theory involves the position in which a child grows in the womb. In certain cases, developing bones might rotate slightly to make the most of available room in the uterus. After birth, it may take some time for these bones to revert back to a standard position.

What to Do

In the case of a rotated tibia (tibial torsion), the bones will tend to correct themselves by the age of 4. In some cases out-toeing will persist longer.

The best practice when discovering your child is out-toeing is to see an expert for a check-up. Dr. Sanjay Patel can rule out potential causes for concern. Periodical examinations can help ensure development is happening smoothly and the condition is not persisting.

Out-toeing that is still present after 3-4 years of age might be more of a concern, and a gait abnormality accompanied by pain most definitely is. If you notice limping, one foot turning out more than the other, a worsening of the condition or other delays in development, then a closer look at the problem is crucial.

If you have concerns about your child’s intoeing or out-toeing, you are far from the only parent. Just like you, we at Family Foot Care & Surgery would rather cover all bases and make sure any potential problems are caught before they become something more difficult to handle. Call 203-876-7736 for our Milford office or 203-288-4055 for our office in Hamden.