When to See a Doctor About My Child's In-Toeing and Out-Toeing

As the terms suggest, in-toeing and out-toeing refer to the situation when feet point inwards or outwards, respectively. As alignments of the feet, in-toeing and out-toeing can be observed by looking at the direction the toes are facing. In both cases, the feet point towards (in-toeing) or away (out-toeing) from the body’s center.

In children, especially when you can’t observe the direction the toes are facing, it’s possible to tell whether a child is in-toeing or out-toeing. As children start walking, they all stumble and struggle to stay upright, but a child with in-toeing or out-toeing can exhibit some unusual movements. These kids might stumble and fall because their toes are not in their natural position.

Parents who don’t know more about the condition have often described it as a ‘pigeon-toe.’ If you notice that your child’s feet point outwards or inwards in a way that doesn’t seem normal, it might be time to make an appointment with our podiatrists.

What Causes In-Toeing/Out-Toeing?

The causes of in-toeing and out-toeing depend on a different range of factors.

1. Metatarsus Adductus

One condition that can cause in-toeing is metatarsus adductus, also known as metatarsus varus. This is a deformity that can be spotted at birth and causes the front half of the foot to lean inward. This deformity affecting the forefoot can range from mild to severe.

Babies aged 6-9 months with cases of in-toeing caused by metatarsus adductus are treated with casts or special shoes.

A point to note is that metatarsus adductus is not to be confused with clubfoot, which is another severe foot deformity. Unlike metatarsus adductus, clubfoot requires treatment right after birth, not once the child starts walking.

2. Internal Tibial Torsion

Internal tibial torsion refers to the inward twisting of the tibia. The twist of the shinbone, which is often noticed once the child starts walking, causes the legs and feet to curl inward. The twisting of the feet might be related to the position of the child in the uterus where it starts to develop.

Usually, tibial torsion is solved without treatment before they reach school-going age.

3. External Tibial Torsion

External tibial torsion is the opposite of internal tibial torsion, referring to the outward curling of the feet and legs. Just like in-toeing, this cause of out-toeing is brought about by the irregular shape of the shinbone.

4. Increased Femoral Anteversion

In or out-toeing can also be caused by increased femoral anteversion. Femoral anteversion is the inward twisting of the femur or thigh bone. This deformity is caused by the excessive rotation of the bones, which changes the direction of the feet by a huge margin, sometimes even up to 70%.

Showing normal feet verses in-toeing and out-toeing

When Should I See a Doctor About In-Toeing/Out-Toeing?

While in-toeing and out-toeing might give parents something to worry about, the condition usually corrects itself, sometimes even without treatment. Parents who notice their kids in-toeing or out-toeing right as they start can often panic, but most of the time, it’s no cause to call the doctor.

However, there are a few circumstances when a parent should bring their baby to our office:

If it is Uncorrected By Age 10

Sometimes, the extent of the deformity can fail to correct itself by the time the child starts going to school. Our doctors recommend that if in-toeing is uncorrected by age 10, it might be time to seek intervention from our family-friendly podiatrists.

When the Child is in Pain or has Trouble Walking

We all love our children, and it’s true that when they’re in pain, we might feel it with them. In scenarios where the child is in pain or has problems walking because of an uncorrected deformity, it’s important to consult our doctors.

An examination can reveal the source of the problem and prepare your child for a faster correction. Checking in with our doctors as the child gets older can ensure that they don’t miss any important milestones. All kids deserve to enjoy the pleasures of running and playing sports/games as much as they want.

Is In-Toeing and Out-Toeing Normal?

Yes, this is a Normal Condition in Young Children

We worry about our children every day, and it’s only natural that we would be concerned about a case of in-toeing or out-toeing. You or a loved one must understand that it’s completely normal. Look at in-toeing as an aspect of development and growing up, and have confidence in the fact that it all gets better with time.

They Should Grow Out of it Naturally

Unless in rare cases, the efficient bodies of children grow to correct everything completely on their own. While doctors can recommend some special shoes to correct the challenge or assist the body to heal faster, it’s all a natural process. In-toeing corrects itself before they are 8 years old, and it won’t cause other conditions such as arthritis.

Treatment Options

Like all conditions, there are various treatment options for in and out-toeing.

1. Casts

Casts are the most popular avenue for the treatment of toe or foot-related deformities. Serial casting works by keeping the foot in the correct position for extended periods as the foot readjusts into the right position.

2. Prescription Shoes

Prescription shoes are an alternative option for situations where casts might make the child uncomfortable or are less severe. These shoes will help their feet heal as they continue with their daily activities.

3. Surgical Intervention

Surgical interventions for in or out-toeing are usually a last resort. Like all surgeries, the main goal of the intervention is to correct the problem and expedite the healing. A surgical intervention that is usually recommended is osteotomy, where bones are broken and realigned to ensure they heal in their “normal position.” This surgical endeavor treats the most severe cases.

Other instances when surgery is recommended include when the child is about 8-10 years old but still has a severe tibial torsion that affects their ability to walk. In cases of femoral anteversion, the condition is corrected via proper alignment after the femur is cut. Of course, doctors are trained to assess each case properly and will prepare you and your child for the procedure to ensure it’s as pain-free as possible.

Contact Us Today to Get Professional Foot Care Services

At Richardson Podiatry, we dedicate ourselves to providing comprehensive and compassionate foot care. We believe that every child deserves a chance to go through all stages of development, and we’re ready and willing to work with parents to make this dream a reality.

If you or a loved one’s child has a case of in or out-toeing, reach out today to speak to a trained professional. Book your appointment by calling (972) 690-5374 or by filling out our online form, and let us take your worries away.