In-toeing and what to do about it

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Something we hear a lot as a paediatric physiotherapist is “My kid walks with their toes turned in – is this normal?”

What is in-toeing?

In-toeing is the appearance of one, or both, feet turning in when standing or walking.  This can be a little bit or a lot.  In-toeing typically comes from the position of either the foot, the shin bone or the thigh bone. Each part influences the final position of the foot when walking. Young children naturally have some internal rotation of the leg and this makes the leg appear turned in. This internal rotation is at its greatest at 2 years of age which also happens to coincide with when children are becoming more mobile with running, jumping and climbing. Parents tend to also start noticing those little legs more and the concern about in-toeing comes up. The good news is that after age 2, the leg naturally starts to ‘de-rotate’, meaning that over a number of years, the leg and foot slowly turn toward straight and then even turn out slightly.  This occurs naturally for most children without any complications.

What does a physiotherapist look at?

Foot position– we assess the curve of the foot and whether or not this is contributing to the in-toeing.  A curved foot generally comes from in-utero positioning and resolves with time.

Tibial torsion– this is the turning in of the lower leg bone (tibia) observed when the kneecaps face forward but the foot turns in.  This is a normal presentation in young children and this typically resolves naturally with time up walking.

Femoral torsion– this is the angle of the thighbone (femur) and how it fits into the hip joint at the pelvis.  It is normal at birth for this angle to result in the leg turning in.  This usually resolves naturally over the first 10 years of life.  Femoral torsion can result in kneecaps pointing toward each other, an awkward run, or your child preferring to W sit.

What can be done about it?

In most cases, children that in-toe when walking will naturally grow out of it over years.  This is not a change that you will see in a few weeks! Thanks to the natural development of our bodies, the legs go from turning in as young children to a slight turning out in adolescence.

When you should bring your child in for an assessment:

See a paediatric physiotherapist for an assessment if:

  • the in-toeing appears to be only on one leg
  • the foot is not flexible or iscurved in significantly
  • your child complains of pain in the legs
  • you notice excessive tripping or poor balance
  • your child has trouble keeping up with peers
  • you are concerned that your child’s in-toeing is greater than normal

The physiotherapist will help determine if their in-toeing falls within typical ranges and give you some strategies to help make sure your child develops strong hip and core muscles.

Written by: Lindsay Eriksson, PT