Is In-Toeing in Kids Normal?

In-toeing, commonly referred to as “pigeon-toed,” means that your child walks and runs with his or her feet pointed inward.  This is usually noticeably soon after a child learns how to walk.  In the overwhelming majority of children, in-toeing will correct itself over the course of several years. Three conditions most often lead to in-toeing:

1.  Flexible hips (femoral anteversion):  This is the most common cause of in-toeing in children and is perfectly normal.  Flexible hips causes both the knees and feet to point inward – you’ll notice that kids with such flexibility can sit in a “W” position on the floor.  As children age, their hips tighten up and their in-toeing resolves.  This generally occurs by puberty (so be patient).  In-toeing itself does not slow a child down or cause them to fall or trip more than other children.  This condition uses to be treated with splints or shoes with a bar connected between them – these treatments do not help and can actually be detrimental.

2.  Bowed legs (tibial torsion):  This occurs when a child’s leg twists inward, which is normal when a child is an infant.  As a child grows older, his or her legs should gradually rotate to align properly.  This condition almost always improves without treatment, and usually before school age.  Splints, shoes, and physical therapy do not help.  Surgery is rarely performed unless the torsion does not resolve by about 10 years of age and it causes significant walking problems.

3.  Hooked foot (metatarsus adductus):  This condition is when a child’s foot bends inward from the middle part of the foot to the toes (not to be confused with a clubfoot, where the foot is rotated internally at the ankle).  This condition usually improves by itself over the first 4-6 months of life.  Babies older than 6 months with a severe deformity or a rigid hooked foot may be treated with casting.  Surgery is rarely required. 

Talk to your child’s pediatrician if you are concerned about your child’s in-toeing.  However, a referral to an orthopedist is not necessarily needed for the reasons described above.

Rachel Brewer, MD

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