In-toeing

Another common concern among parents is that their child walks "pigeon-toed". A parent's first response might be, "Oh, no! My child will never be able to play sports in school." It should be pointed out that there is no such thing as "terminal in-toeing". Most children who in-toe will live a happy, normal life. Some sports experts have suggested that sprinters may have an advantage by being in-toed. Occasionally the deformity is severe enough to cause pain, shoe irritation and tripping, and it can predispose a foot to have other problems. Social concerns are also valid due to the "bully" attitude on the playground.

In-toeing simply stated, is a foot that points toward the midline of a person's gait (or walking pattern). At first glance, it might seem like a deformity of the foot, but in-toeing can be the result of any rotational over-growth or under-growth at any bone or joint from the foot up to the hip. For example, a common cause of in-toeing in children under age two is not enough tibial torsion. The main bone in the lower leg (tibia) has a normal growth development that includes a twisting of the leg in an outward direction. If this does not undergo its full rotation, a child can have a foot that appears in-toed. If the leg rotates too much, then the reverse effect will result in an out-toe position of the foot.

The most common cause of in-toeing among children between the ages of two to ten is excessive inward twisting of the bone in the upper leg (femur)—this is referred to as femoral anteversion. The hip joint undergoes rotational changes in an inward direction through adolescence. If the femur is twisted inward too much, then the normal inward twisting of the hips can bring on an in-toed gait around ages two to four. Fortunately, most children will slowly grow out of this deformity.

Another reason a child may have an in-toed gait is due to a deformity in the foot itself. If your child’s foot appears to be curved inward exhibiting a “C-shape,” metatarsus adductus or hallux varus may be the reason. Either the metatarsals (long bones to the toes) or the hallux (big toe) can be pointing inward. These deformities will usually be seen at birth, but can appear to worsen with time. It is good to evaluate this prior to a child's walking because conservative treatment options decrease with age. Initially special shoes, bracing, and casting may suffice. In older children, if these treatments are not satisfactory, surgery may be indicated.

Because the development of the child's leg and foot is a gradual process, it is not uncommon for a doctor to tell a parent, “Your child will grow out of it.” While most of time this is true, there is an occasion when the deformity will not correct itself. Early detection and close monitoring will increase the treatment options and outcomes.