Foot Notes Blog


June 2011

Is my child's in-toeing serious?

Jun 12, 2011 2:27 PM
Peter Guy

I have treated many children with foot problems over the past 26 years. One of the childhood foot problems that I have treated is in-toeing. In-toeing occurs in about 2 out of every 1000 children.
Many parents become concerned when they see their child’s feet pointing inwards while walking, especially if it is associated with tripping. Other concerns include the abnormal shoe wear on the outside of the toe box due to scuffing of the toes while walking, the child complaining of being tired after walking or the child asking to be carried instead of walking.

My goal as a chiropodist/podiatrist is to inform the concerned parent that in-toeing almost always self corrects as the child grows towards adulthood.

If you watch the majority adults walk you will notice their feet will point straight ahead or outward. In-toeing ("pigeon toes") describes a position where the feet turn inward instead of pointing straight ahead during walking or running. In-toeing happens from birth to adolescence due to a delay in rotational or torsional unwinding during a normal bone development. There may be a prior family history of in-toeing. Prevention is not usually possible because the causes are due developmental or genetic reasons.
There are three causes of in-toeing:
  1. Internal femoral torsion (also called femoral anteversion) occurs when the femur or thigh bone has an inward twist in the shaft of the bone.
  2. Internal tibial torsion occurs when the tibia or shinbone in the lower leg has an inward twist in the shaft of the bone.
  3. Metatarsus adductus occurs when metatarsal bones in the foot are bent inward like the shape of a kidney bean.
These three causes of in-toeing can be identified by performing a series of measurements which involves taking six different measurements of the angles of the feet, legs, and hips when the child is in various positions. A gait analysis is also performed to observe to position of the knee cap and while walking or running. This combination of examinations allows for detection of the three causes of in-toeing.
Is in-toeing serious?
The tripping associated with in-toeing is the parental concern that usually initiates an office visit. Apart from this concern, children with in-toeing are generally healthy and have no limitations in their activities or sports. Parents can expect their child to live a normal, active, and healthy life. Some young children with in-toeing may have problems getting shoes that fit, because of the curve in their feet. A shoe fitting problem might make parents consider treatment for their child. In very rare cases, some children have a severe twist in the leg bone (tibia) or thigh bone (femur), which can be a concern because it looks bad or causes tripping, but as mentioned before in-toeing can self correct by adulthood. In a very tiny proportion of children with in-toeing, surgery may be required to correct in-toeing due to severe internal femoral or tibial torsion.
In summary, the vast majority of children who have in-toeing will gradually self correct until their feet point straight ahead as they develop into adults. The tripping associated with in-toeing also reduces over time.

Please follow the link to find further information on the causes and treatments for in-toeing at



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