Many parents observe their babies walking with feet turned inward, often called “pigeon-toed.” While this might look unusual, this inward foot position is frequently a normal part of a child’s development as they learn to walk and gain balance.
Understanding In-Toeing
The medical term for feet turning inward is “in-toeing.” This means the feet point towards each other rather than straight ahead when a child walks or runs. It is common in young children and, in most instances, represents a normal developmental variation. Unlike clubfoot, which involves a foot deformity, in-toeing typically involves a rotation in the leg bones above the foot, with the foot structure remaining healthy.
In-toeing is often first noticed when a child begins walking, but it can appear at various ages. While it may cause a child to trip more frequently, it typically does not cause pain. Most children with in-toeing learn to walk, run, and play without limitation.
Common Causes of In-Toeing
In-toeing typically stems from rotational differences in the leg bones, often influenced by a baby’s position in the womb. Three primary anatomical reasons account for most in-toeing cases.
Metatarsus Adductus
Metatarsus adductus occurs when the front part of the foot curves inward, giving it a “C” or “bean” shape. This condition is usually present at birth, thought to result from the baby’s position in the uterus. Most cases are flexible, meaning the foot can be gently straightened, and resolve spontaneously within the first 18 months of life, often by 6 months.
Internal Tibial Torsion
Internal tibial torsion involves an inward twist of the shin bone (tibia). This inward rotation often develops before birth due to the confined space of the womb. It commonly becomes noticeable when a child begins walking, typically between 1 and 3 years. The tibia naturally rotates outward as a child grows, with most cases resolving by around 5 to 6 years.
Femoral Anteversion
Femoral anteversion is an inward twist of the thigh bone (femur), causing both the knees and feet to point inward. This condition is often most apparent in older toddlers and pre-schoolers, typically between 4 and 6 years, and can be related to the fetal position. Children with femoral anteversion might find it comfortable to sit in a “W” position. The inward twist of the femur usually corrects itself as the child matures, often by 9 or 10 years.
When to Seek Medical Advice
While in-toeing often resolves without intervention, certain signs warrant a consultation with a healthcare professional. Seek medical advice if the in-toeing worsens over time or if a child frequently trips or falls due to it.
Other indicators for assessment include in-toeing affecting only one leg, causing limping, or pain in their hips or legs. Medical evaluation is also recommended if in-toeing persists significantly beyond school age (8 to 10 years) or if there are associated developmental delays. These signs can suggest a need for further investigation.
Resolution and Management
Most cases of in-toeing resolve naturally as a child grows and their bones develop and align. Observation is the most common approach, as the condition often improves without specific interventions. The natural untwisting of the bones can take several years.
Interventions such as special shoes, braces, or casting are generally not effective in accelerating the resolution of in-toeing and are rarely needed. These methods have not been empirically supported to improve the condition faster. In rare and severe cases, when in-toeing persists and causes significant functional problems in older children, surgical correction may be considered to realign the bone. However, this is an infrequent course of action.