In-toeing & Out-toeing in Children

Watching your child take his or her first steps is always a memorable experience. Those first few steps are not always perfect. However, with time and practice, each step becomes more firm and stable.

As parents often notice, many children start walking with their feet and toes turned at an angle. This is referred to as “in-toeing” (or “pigeon-toed”) when the feet point inward, or “out-toeing” when they point outward. Though it can be disturbing to see your child develop an abnormal gait, neither in-toeing nor out-toeing in toddlers should worry you. In-toeing occurs in approximately 30% of children up to 4 years of age and may resolve as late as 14 years. In-toeing is also more common than out-toeing. Both conditions do not cause pain and will improve as the child grows.

Causes of In-toeing and Out-toeing

Most in-toeing and out-toeing in toddlers is as a result of a slight rotation (or twist) of the upper and lower leg bones.

Tibia torsion, also referred to as “twisted shin,” is the most common cause of in-toeing. It occurs when the tibia (lower leg bone) turns inward. Conversely, if the tibia tilts outward, out-toeing will be observed.

It is also possible for the thigh bone (femur) to be tilted, resulting in either in-toeing or out-toeing of the feet. This is medically referred to as femoral anteversion, and is most obvious between the ages of 3-7. Femoral anteversion is more commonly observed in girls.

While in the womb, the cramped posture of the fetus may contribute to a child developing in-toeing or out-toeing. This is because as the fetus grows, some bones rotate to fit into the small uterine space. However, it’s not always medically clear what causes these conditions. Genetics can play a significant factor.

Can In-toeing and Out-toeing be Treated?

Generally, there are no specific treatments for in-toeing or out-toeing conditions. Braces and shoe inserts have proven ineffective, because the bones will normally improve (properly align) as the child grows. Doctors have found that using these types of devices provides no treatment benefit. They don’t correct the issue, and they don’t shorten the amount of time it takes to resolve in-toeing or out-toeing.

Furthermore, children with in-toeing or out-toeing generally have no limitations while participating in sports activities, whether at a recreational or competitive level.

Improvement in Walking

While a child is growing, their bones also gradually rotate to a normal position or angle. At the same time, the child becomes better at controlling muscles and foot position, leading to improvements in walking and running form.

Since in-toeing and out-toeing are naturally corrected over a period of time, these improvements are incremental and sometimes difficult to notice. As such, doctors will recommend that parents periodically take video clips of their child while walking. With a time gap of 12 months between video clips, it becomes possible for parents to see the improvement in the feet.

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