Intoeing and Out-Toeing

One of the first things new parents check is to make sure all fingers and toes are present when their baby is born.  They ask doctors and nurses all sorts of questions, most centered around finding out if everything is normal. As their child grows, they still have questions surrounding their child’s health – and wonder if their little one’s development is normal.

For example, as children continue to grow, many parents see a child’s feet pointing in or out and begin to worry. Most often, there is little need for concern, because intoeing is fairly common and many children outgrow it by the age of 8 to 10 without needing treatment. Out-toeing is not quite as common, but this issue is also often outgrown over time. When to worry about your child walking funny

Foot Development

While the baby is in the womb, he or she is curled up in a rounded shape and the legs and arms are nestled against the tiny torso. Following birth, it will take time for your infant’s arms, hands, legs, and feet to extend straight and develop muscle strength. In addition to muscle strength, bones also become stronger. In time and the feet, legs, and spine will begin supporting your child so that he or she can crawl, stand, walk, and eventually run.

There are three main conditions that can potentially cause your child’s feet to curve inward or outward:

Metatarsus Adductus - When the cause of intoeing is metatarsus adductus, the front part of the foot is curved inward. This can be recognized by the sole of a foot that looks like a “quarter moon” shape. The severity of the condition can vary from a flexible, gradual curve of the foot to an extreme one that is rigid and stiff. Parents are normally relieved to find out that the curved feet will eventually straighten on their own, often around 6 months of age.

Our doctors can monitor your baby’s foot development over the first few months to ensure there are no other issues, but treatment is probably not necessary. Should treatment be recommended, you may want to gently stretch your child’s foot into a straight position a couple of times each day. Your child’s bones are still soft and pliable, so this will not cause any pain. Even in the case of very rigid and curved feet, the bones are soft enough that casts or special shoes can be used if needed.

Medial Tibial Torsion - In some cases of intoeing or out-toeing, the problem is higher up than the foot. With medial tibial torsion, a toddler will often stand bow-legged and feet appear to be in a pigeon-toed position. This results from a twisted shin bone (tibia) that developed while in the womb. As with the case of metatarsus adductus, the condition may only need close monitoring to ensure that your child is developing in a normal manner.

In the past, special shoes and braces were commonly prescribed to address this issue, but they were never proven to actually promote quicker leg straightening. As such, they are no longer used. Instead of medical devices, we have found that the gait will correct naturally over time as the child walks and builds stronger leg muscles.

Femoral Anteversion - As a child reaches “school age,” he or she may have either one or both legs that seem to turn in or out at the knees, to accompany inward or outward turning of the feet. This is the result of a condition known as femoral anteversion, which is an upper thigh bone that is abnormally turned.

Babies are often born with the top of their thighs twisted about 40 degrees inwards, but this twisting will disappear in time. As is the case with medial tibial torsion, shoes and braces have not been proven to properly address the issue. Femoral anteversion generally resolves itself by the age of 10. In the event this does not happen, a surgical procedure to straighten the thigh and improve an abnormal gait may be recommended.

Professional Care for Intoeing and Out-Toeing

Don’t be overly concerned if you notice your toddler is intoeing or out-toeing. If you have any questions, simply call Foot & Ankle Associates of Florida at 407-339-7759 or 352-589-9550 (if calling from Lake County). You can also request an appointment for your child with any of our five Florida offices—Kissimmee, Lake Mary, Altamonte Springs, Tavares, and Orlando—online today.