All About In-Toeing

When children first begin to walk, they will experiment with all sorts of funky positions for their feet and legs as they learn to maintain their own balance while taking their first steps. During this time, parents may notice their child’s toes pointing inwards (pigeon-toed) or outwards (duck-footed). During years when they are first learning to walk , a small amount of in-toeing or out-toeing can be completely normal.

A child might in-toe for a variety of reasons depending on whether the pattern is stemming from the hip, shin, or foot.

In-toeing can result from:

• Metatarsus adductus: a foot deformity that causes the feet to point inwards, usually seen at around 1 year of age

• Internal tibial torsion: the shin bone being twisted inwards

• Femoral anteversion: the positioning of the thigh bone at the hip joint causes the leg to turn inwards (most common and normal for preschool age)

• Neurological conditions such as cerebral palsy or muscular dystrophy

Mild cases of metatarsus adductus will usually resolve on their own between 4-6 months, but other cases will usually be seen around 1 year of age. Children are born with more femoral anteversion and internal tibial torsion than adults, making these two the most common reasons for an in-toeing walking pattern. Femoral anteversion can sometimes be perpetuated by frequent W-sitting. Both conditions will usually self-correct by around 8-10 years old without intervention. Therapists may sometimes recommend hip stretches or alternative sitting positions to decrease the amount of in-toeing.

Overall, mild in-toeing (especially in the early walking stages) is a normal walking pattern for most children and shouldn’t be cause for alarm. However, if your child is experiencing pain or swelling throughout their legs and/or feet, walks with a limp, is asymmetrically in-toeing, or is limited in their ability to move around because of their foot positioning, contact us to see how we can help! We’ll go into out-toeing in our next post.