Learning to walk is a process, and children rarely look like experts at first. But as you watch your child develop, you may notice their toes might not point straight ahead when they stand and walk. Feet that turn inward (in-toeing) or outward (out-toeing) are relatively common among young children, but should still prompt an evaluation by a podiatrist. We can determine whether the issue is structural or functional and help protect feet and legs during their development.

Types of In-Toeing and Out-Toeing

In-toeing and out-toeing are generally classified based on where the primary rotation occurs.

  • The foot itself could be curved inward, almost appearing bent. This is called metatarsus adductus.
  • The shinbone (also known as the tibia) might be rotated inward or outward. This causes the entire shin and foot to point away from center. This is called internal tibial torsion if the toes point inward, and external tibial torsion if they point outward.
  • The thigh bone, or femur, might be rotated inward or outward. This, of course, causes the entire leg, including the knee, to point away from center. If the toes point in, it’s femoral anteversion. If they point out, it’s femoral retroversion.

What Causes In-Toeing and Out-Toeing?

The root causes of in-toeing and out-toeing are not always clear. However, evidence suggests that genetics and family history may have a role to play. If a parent or relative was born with in-toeing or out-toeing, there is a greater than normal chance their offspring will, too.

Some cases are thought to be a result of fetal positioning within the womb. In order to fit in this cramped space, some of the bones may need to be rotated slightly. After birth, the bones may stay partially rotated.

A child's feet pointing inward

Does My Child Need Treatment?

Regardless of how old your child is or when you first notice in-toeing or out-toeing, you should book an appointment for an evaluation. Some types of in-toeing or out-toeing may not become apparent until children are a little older, even 5 or 6 years of age.

The good news is that, most of the time, in-toeing and out-toeing will resolve naturally before they reach adolescence. However, this is not always the case, and even when it is, the process occurs gradually. The Northwest Extremity Specialists can determine if any more serious structural defects or neuromuscular conditions need to be addressed, and they can also help you monitor your little one’s progress and protect them as they grow.

How Are In-Toeing and Out-Toeing Treated?

Treatment options vary depending on the nature of the condition, age of the child, and other factors. Conservative treatments that may help in some cases include orthotics, phyiscal therapy, braces, and casting. If the deformity is severe, surgery may be required. Surgery is usually only recommended for older children, but there may be exceptions based on the situation.

If you observe your child’s toes pointing inward or outward as they walk—or any other odd abnormalities in the way they walk—please take them to one of the pediatric foot specialists at Northwest Extremity Specialists. Complete an appointment request form, or call the location closest to you to schedule directly.