It takes time for little ones to sort out their legs. Bones and muscles are still growing and developing throughout childhood and adolescence, and until they complete that process there may be some things that look a little amiss. In fact, it’s quite common for children’s toes and feet (on one or both legs) to point inward (called in-toeing) or outward (out-toeing) at various points of their development. Cases almost always resolve on their own, and are usually quite harmless as well.
But why does this happen, and when should you be concerned?
Most cases of in-toeing and out-toeing are classified as one of three main conditions, which vary both in terms of where the actual “twist” occurs, and when it’s most likely to affect your child:
- Metatarsus adductus, a twisting of the foot. It’s most common between birth and 2 years of age. It can also cause out-toeing, depending on the direction of rotation.
- Internal tibial torsion, a rotation of the shinbone at the knee. You might not notice this until age 2, when your child begins walking.
- Femoral anteversion, a rotation of the femur at the hip. The knee caps will noticeably point inward. The condition is usually apparent around the ages of 3 to 8.
Although less common, out-toeing conditions tend to be “mirror” versions of in-toeing conditions:
- External tibial torsion. Essentially the same as internal tibial torsion, except with the shin rotated out rather than in.
- Femoral retroversion. Like anteversion, it involves a rotation of the femur; however, it may be obvious at a younger age, and has a higher risk of leading to complications such as early arthritis or pain.
Why Do In-Toeing and Out-Toeing Occur?
The fundamental causes of these conditions is not well understood, but both genetics and condition in the womb are thought to play a role in at least some of the conditions. Family history seems to have some predictive value, and tight, cramped spaces in the womb may lead to rotated joints that slowly realign themselves as the child grows up.
What’s the Best Treatment? Should You Be Concerned?
As soon as you notice an abnormality in the position of your child’s feet, you should take them in for a quick check-up just to make sure there are no serious underlying conditions (such as nerve issues) that may require additional attention. That said, such complications are very rare.
In the vast majority of cases, observation is the best course of action. Treatments such as special shoes, orthotics and braces are not necessary, and in any case do not speed the pace of recovery anyway. The good news is that in-toeing and out-toeing usually go away on their own, and if your child is showing no symptoms of discomfort or walking difficulties, you need not worry. Kids who toe in or toe out can run, jump, and even play competitive sports just as well as those with “normal” toeing.
That said, keep an eye out on your child as they grow—you may even want to take pictures every couple of months to make comparisons. It may be time for another appointment if:
- You notice your child experiencing pain or having walking difficulty associated with toeing in or out
- You notice the twisting getting worse, not better
- The condition does not improve by a certain age—often 3 or 4 for some conditions, or closer to 8 or 10 for others. We’ll tell you at your initial appointment what a “normal” course looks like, depending on the specific condition.
Only once we’ve determined treatment is necessary will we consider more specialized care, such as bracing or casting. Very rarely, we may recommend surgery to rotate the bone if functional problems are not corrected by age 10 or so.
Foot Care for Your Family in Austin, TX
Dr. Keith McSpadden at North Austin Foot & Ankle Institute is dedicated to providing the highest quality of foot care for you and your little one—even when the best care is simply to let you watch your child grow up. To schedule an appointment in Cedar Park or Round Rock, TX, book online or give us a call at 512-593-2949.