In-Toeing and Out-Toeing
The way the feet point has a lot to do with gait, or how a person walks. Children (and adults) can sometimes develop conditions known as in-toeing and out-toeing. This means that instead of pointing forward normally, the toes point either inward or outward. This can affect not only the way a person walks, but how their hips and legs work as well.
Also called pigeon-toeing, it is when the feet point in towards each other. Many children will eventually just grow out of this problem, but not all do. There are different biomechanical causes for in-toeing. The three most common are metatarsus adductus, tibial torsion, and femoral anteversion. Metatarsus adductus is when the feet begin to curve near the middle of the foot. It may be flexible or rigid and it is usually corrected on its own. Tibial torision occurs when the tibia (lower leg) twists inward. This type usually corrects itself by the time the child starts walking and the tibia grows longer. Femoral anteversion occurs when the femur (thighbone) twists inward. It usually spontaneously fixes itself as the child continues to age and develop.
This condition is not seen as frequently as in-toeing. It can occur because the child has flat feet, which causes the appearance of “duck feet.” When flat feet are the cause, there is usually no treatment required, as long as there are no other symptoms. Another reason for out-toeing is external tibial torsion. This means that the tibia is twisted outward. It usually affects children later in childhood and is often seen in only one leg, not both. Hip contracture is a third reason your child may toe out. This is just a fancy way of saying that the hips are turned outward. This usually occurs during gestation because of the placement of the fetus. Hip contracture will usually fix itself. Lastly, femoral retroversion can lead to out-toeing. This means the femur is tilted backwards, causing the entire lower extremity to point outwards. This is typically seen in children who are obese.
Treatment for Toeing Problems
Treatment is not always necessary, because most of these problems will spontaneously sort themselves out. However, if there is pain associated with any of these toeing issues, there are things that can be done to help with that. Treatments such as special shoes, custom-made orthotics, physical therapy, and chiropractic manipulation often do not help, although metatarsus adductus can be treated with casts or orthopedic shoes. If tibial torsion and femoral anteversion do not fix themselves on their own you might be looking at surgery as a necessary option. A doctor will usually wait until the child is a bit older and then reset the bone. The same thing is done for children with severe cases of out-toeing. If it interferes with daily life, it can be surgically fixed by resetting the alignment of the bones.