Intoeing refers to the condition where the feet curve inward instead of pointing straight ahead when walking or running. This is a common occurrence in young children and is typically outgrown naturally without the need for special shoes, stretching exercises, or other treatments. By the age of 2, most children will walk with their feet pointing straight ahead or slightly outward.
Outtoeing, on the other hand, is when the feet angle outward excessively. Although less common than intoeing, outtoeing is generally part of normal development. If you are concerned about your child's walking pattern, it is advisable to consult with your pediatrician during a routine well-child visit for reassurance.
Types of Intoeing and Outtoeing
- Tibial Torsion: This involves the in-turning of the child's lower leg (tibia). During the fetal stage, the legs are in a confined position. Tibial torsion occurs when the legs do not rotate to the turned-out position after birth. This condition typically improves on its own without treatment, usually by age 4. Splints, special shoes, and exercise programs are ineffective. Surgery is considered only if the child is at least 8-10 years old and the condition persists or causes significant walking issues.
- Femoral Version: This is the in-turning of the child's upper leg (femur) and is most noticeable around the ages of 5-6. The exact cause of femoral version is unknown, but it usually resolves without treatment. Modified shoes, braces, and exercises do not help. Surgery is considered only for children older than 9 years with severe cases that cause frequent tripping and a noticeable gait.
- Metatarsus Adductus: This common birth defect causes the feet to bend inward from the middle to the toes. In severe cases, it can resemble clubfoot deformity. Most cases improve on their own, so treatment is often delayed until the child is several months old. When treatment is necessary, it typically involves casts or special corrective shoes, which are highly successful in babies aged 6-9 months.
Other Common Conditions
- Bow Legs and Knock Knees: These conditions cause the legs to curve outward or inward at the knees, respectively. Both conditions are normal in young children and usually straighten out as the child grows. Special shoes and wedges do not help either condition.
- Flat Foot: Flat feet are normal in infants and young children, as the arch develops until at least age 5. Special wedges, inserts, or heels are not needed.
Should I Be Worried About My Child's Intoeing?
Generally, there is no need to worry about a child's intoeing. It is a common misconception that intoeing in children under the age of 8 will lead to permanent deformities. Intoeing usually corrects itself without the need for casts, braces, or surgery and does not cause pain, interfere with learning to walk, or lead to degenerative arthritis in adulthood. If intoeing persists past the age of 8 or causes walking problems, it is advisable to consult your pediatrician or Dr. Kamel.