Intoeing and Out-Toeing

It takes a while for even completely normal, healthy children to develop a smooth, confident, adult-like walking style. That said, parents may still notice certain oddities or abnormalities that give them cause for concern. One of the most common “defects” reported is feet that point inward (intoeing) or outward (out-toeing), rather than straight ahead.

Intoeing and out-toeing do not always require treatment beyond observation, and many children will outgrow it by age 2 or 3. However, these conditions should always be checked by a podiatrist. If there’s a more serious underlying condition (for example a nerve issue) it should be identified as early as possible. Even if there isn’t, an evaluation provides both peace of mind and a clear point of reference from which to track future progress.

Types of Intoeing and Out-Toeing

The terms intoeing and out-toeing are broad definitions that can refer to multiple specific diagnoses. The location of the “twisted” bone is the main point of differentiation. For example.

  • The feet themselves are turned inward. All the leg bones appear to be in proper alignment, but the front portion of the foot itself is bent or turned. This is known as metatarsus adductus, and is a relatively common congenital deformity. About 9 in 10 cases resolve on their own.
  • The lower legs (shin bone) are turned inward or outward. Because the rotation is in the shins, the whole lower leg (including the ankles) will point in the wrong direction. This condition is known as tibial torsion (internal or external, depending on whether toes point in or out).
  • The upper legs (femur) are turned inward or outward. If this is the case, the knees will also point inward or outward along with the feet. This is called femoral anteversion if it causes intoeing, and femoral retroversion if it causes out-toeing.

What Causes Intoeing and Out-Toeing?

The exact causes of intoeing and out-toeing are not known. However, many cases are thought to be related to intrauterine packing—or in other words, the position of the child within the womb. Certain bones may be slightly rotated from their normal positions in order to accommodate the space. After the child is born, these bones usually slowly “unwind” themselves over the next few years.

There may also be a genetic component, with some evidence to suggest that intoeing or out-toeing conditions may be more likely if a parent or grandparent had the same issue.

Will Intoeing or Out-Toeing Affect My Child’s Development?

In most cases, the answer is no. Unless the deformity is severe, most kids will not feel any pain or experience any significant physical limitations or developmental delays. However, you should always check with a podiatrist first.

How Are Intoeing and Out-Toeing Treated?

Treatment depends on factors such as the underlying cause of the deformity, the extent or severity of the rotation, any secondary symptoms or consequences your child may be experiencing, and age.

In most situations, the only treatment initially prescribed is observation. Since most kids will grow out of their intoeing or out-toeing within the first few years of life, the best course of action is to simply keep an eye on them and determine whether the problem is getting better, getting worse, or not changing. Since this process occurs very slowly, taking photos and video recordings of your child walking is a great resource to help you identify and mark progress.

Kids with severe deformities, or those who do not grow out of them by a certain age, may need additional treatment, and occasionally surgery. Treatment decisions are made on a case-by-case basis.

Are your child’s feet pointing far from straight ahead? Let our New Jersey children’s foot care experts take a look. Schedule an appointment in Princeton by calling (609) 924-8333, or in Roselle Park at (908) 687-5757.