In-toeing & Out-toeing (Pediatric)

What are in-toeing and out-toeing?

Most people's feet point straight ahead or slightly outward. Some people's feet, however, point inward. In-toeing affects infants and children and is generally noted by an inward rotated foot or feet. Out-toeing is just the opposite with an outward twist to the leg.

What causes in-toeing and out-toeing?

There are three common causes of in-toeing:

1. Femoral torsion (also called femoral anteversion), in which the femur, or thighbone, is rotated inward. The child will stand with the kneecaps and toes pointing inward.
2. Tibial torsion which is marked by an inward twist of the tibia or shinbone in the lower leg
3. Metatarsus adductus in which the foot is bent inward like a kidney bean. Generally, the curve is very flexible and the foot can be straightened by gently pushing it in the opposite direction.

Out-toeing is much less common than in-toeing, but is caused mostly by an outward twisting of the shin bone (tibia) or the thigh bone (femur).

How are in-toeing and out-toeing diagnosed?

Generally a physical exam including watching the child walk (if they are walking independently) is the only thing necessary to diagnose in- or out-toeing. Rarely an x-ray is needed.

How are in-toeing and out-toeing treated?

In general, there are no treatments necessary as the common causes listed are normal variations in a growing child.

No bracing or shoe inserts have been shown to be effective since the twist in the bones usually improves over a period of time as the child grows and develops.

Children with in-toeing or out-toeing go on to have no limitations in their activities, from simple outdoor games to competitive sports.

While rotational problems may present some early challenges for children and parents alike, parents can expect their child to live a normal, active, and healthy life.

If a functional problem exists and the child is unable to walk or run effectively then a visit with a pediatric orthopedist may be warranted.