Ronald W. Smith, M.D.

In-Toeing and Out-Toeing

intoeingI.      Definition:  In-toeing and out-toeing are common developmental problems in children. In-toeing is a condition where a child’s feet are turned inward, sometimes referred to as “pigeon toed.” It is often associated with a knock-kneed appearance. Out-toeing is when the feet are turned outward. These conditions usually become apparent shortly after the child is born or when the child begins to stand or walk. In-toeing and out-toeing:

  • May cause a child to stumble or trip (however, falling is also a normal part of the learning to walk process).
  • Do not usually cause pain.
  • Do not usually interfere with the way a child learns to walk.
  • Have not been linked to degenerative arthritis in adulthood.

II.      Cause:   In-toeing and out-toeing can result from a number of different conditions and may be linked to the child being tightly packed in the mother’s womb. In-toeing and out-toeing are commonly caused by a twist in the leg bones, which forces the foot to turn inward or outward. The twist occurs most commonly in the shinbone, a condition called internal tibial torsion, but can also occur in the thigh bone, a condition called femoral anteversion.

III.      Treatment and Prevention:  In the first few months after birth, most children naturally outgrow in-toeing and out-toeing conditions without treatment. If the condition persists past 6-12 months of age, a nighttime brace called a Denis-Browne boot and bar may be the recommended treatment. Certain sitting positions have shown to help correct in-toeing; it is recommended to sit cross-legged and discourage “W” sitting. Ballet, ice skating, roller skating, and bicycle riding may be useful exercises to help realign the leg bones. If the condition is still present at age 8-10, surgery may be a consideration.

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