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What Are Intoeing and Outtoeing?

Intoeing means that the feet curve inward instead of pointing straight ahead when walking or running. If your young child has intoeing, he or she probably will outgrow the condition naturally. You don't need special shoes, stretching exercises, or other treatments. By age 2, most children walk with their feet pointing in the direction they are heading or pointed slightly outward.

If the feet angle out excessively this is called outtoeing. It isn’t as common as intoeing, but in most cases, it is also just part of normal development. If you want reassurance that your child is walking normally, ask your pediatrician during a routine well-child visit.

Types of Intoeing and Outtoeing

Tibial torsion: In-turning of your child's lower leg (tibia). In the womb, the legs were in a confined position. Tibial torsion means the legs didn't rotate into the turned-out position after birth. The condition improves without treatment, usually before age 4 Splints, special shoes, and exercise programs don't help. Consider surgery only if your child is at least 8-10 years old and the problem has persisted or causes significant walking problems.

Femoral version: In-turning of your child's upper leg (femur). It's most apparent when he or she is 5-6 years old. Doctors don't know why femoral version happens. It gets better without treatment. Modified shoes, braces and exercises don't help. Consider surgery only if your child is older than 9 years old and has a very severe condition that causes a lot of tripping and an unsightly gait.

Metatarsus adductus: A common birth defect in which a child's feet bend inward from the middle of the foot to the toes. In severe cases, it may resemble clubfoot deformity. Since the condition improves by itself most of the time, most newborns with it are not treated until they're at least several months old. Treatment, when necessary, usually involves applying casts or special corrective shoes and has a high rate of success in babies aged 6-9 months.

Other common conditions in children include bow legs and knock knees, in which the legs curve outward or inward at the knees. A wide range of knee alignment is normal in young children and usually straighten out as your child grows. Special shoes and wedges don't help either condition.

Flat foot is also normal in infants and young children. The arch develops in your child's foot until at least age 5. You don't need special wedges, inserts or heels.

Should I be worried about my child's intoeing?

No. Although some people believe a child or infant with intoeing will have permanent deformities as an adult, intoeing in children under age 8 usually corrects itself on its own without casts, braces, or surgery. Intoeing usually does not cause your child pain, interfere with learning to walk, or lead to degenerative arthritis in adulthood. If the problem continues past 8 years old or causes problems with walking, talk to your pediatrician or a foot and ankle orthopaedic surgeon.


Contributors/Reviewers: Sudheer Reddy, MD; Hui Zhang, MD

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