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Intoeing and Out-toeing: What Parents Should Know

Imagine your child standing on his or her own for the very first time. It’s a proud moment for any parent. You’re excited to see your child reach this milestone. What might concern you, though, is noticing your baby’s feet pointed inward, pigeon-toed. Or perhaps his or her toes point outward. Intoeing and out-toeing can scare many parents, but these gait abnormalities aren’t as bad for your children as you might think.

Unusual First Steps

Intoeing and out-toeing are actually fairly common gait issues for small children, and they may or may not actually impact a child’s ability to walk normally. Both can be mild issues your child was born with, or serious side effects of neuromuscular disorders—though that’s rare. Intoeing, which is the more common of the two, can be caused by a few underlying conditions. Metatarsus adductus is a curve in the bones of the midfoot. Typically this is flexible and visible at birth. Tibial torsion is a slight twist in the shin bones that causes the toes to point in. Usually you notice this as soon as a child starts walking. Femoral anteversion is an abnormal twist of the upper thigh at the hip. You normally notice this by two to four years old.

Out-toeing is much less common. Typically it’s caused by an outward twist of the leg bones at the hips. Many babies are born with this rotation, though for most children the problem resolves on its own fairly early on. Occasionally it lingers, causing the toes to point outward as your child learns to walk. An actual outward twist in the thigh or shin bones is also possible. This, however, is pretty rare and is usually related to a serious neuromuscular disorder.

Why Parents Are Concerned

Most parents are concerned that their pigeon-toed child will have trouble learning to walk normally. Toes that point in or out may trip up a child who’s new to walking. You might be concerned about finding shoes to fit feet with metatarsus adductus later in life, too.

The good news is that these conditions don’t usually cause any trouble for a young child. They don’t cause pain or lead to arthritis. Children generally outgrow them by school age. In the rare case that they do not outgrow them by age ten, and they cause pain or distress for the child, there are procedures to correct the issue.

Monitoring and Managing

If your child displays signs of intoeing or out-toeing, Dr. Noah Levine will carefully examine the lower limbs to diagnose the underlying problem and check for neuromuscular diseases that might have contributed to the problem. Once we better understand the condition, we can move forward to help care for your child’s feet.

Unfortunately, in most cases, traditional conservative care doesn’t benefit conditions. Bracing, special shoes, and even physical therapy do next to nothing to speed up the process of the feet straightening out if your child has rotations in the hips, thighs, or shins. These gait abnormalities are very common and usually don’t have any negative, much less long-term, impacts on your child’s feet or ability to walk normally. Monitoring them to make sure they don’t cause problems is usually all your child needs.

Metatarsus adductus, though, does often benefit from stretching your baby’s feet to keep them flexible as they grow. Stiff or severe cases may be manipulated and casted, much like clubfoot, to help straighten out the lower limbs. Only in rare cases is any type of surgery needed.

As unnerving as it can be to see your child intoeing or out-toeing, you don’t have to worry. Unless there is a neuromuscular issue, or the problems are particularly severe, the feet outgrow the pigeon-toed look within a couple years. We will keep an eye on the development to make sure everything progress appropriately, of course. In the extremely rare case that the problem persists past age ten and causes pain or difficulty walking, we will consider surgical action. Let Absolute Foot Care Specialists monitor the issue and make sure your child grows normally. Just call (702) 839- 2010 if you are concerned. You can also use the website to reach us.