Your Orthopaedic Connection: Intoeing

Intoeing

Intoeing means that the feet turn inward instead of pointing straight ahead during walking or running. This is commonly found among children at various ages and for different reasons. Intoeing almost always corrects without treatment as the child grows older.

Causes

The cause of intoeing depends on where the change in alignment is centered. There are three common conditions causing intoeing: curved foot (metatarsus adductus), twisted shin (tibia torsion), and twisted thigh bone (increased femoral anteversion). Each of these conditions may run in families. They also can simply occur on their own or in association with other orthopaedic problems. Prevention is not usually possible because they occur from developmental or genetic problems that can't be controlled for.

Metatarsus Adductus

Metatarsus adductus in an infant. (Courtesy of Texas Scottish Rite Hospital for Children)

This is present when the child's feet bend inward from the middle part of the foot to the toes. Some cases may be mild and flexible, but others may be more obvious and rigid. In severe cases, metatarsus adductus may resemble a clubfoot deformity.

Tibial Torsion

Tibial torsion in a young child. (Courtesy of Texas Scottish Rite Hospital for Children)

This can occur if the child's lower leg (tibia) twists out of normal alignment. This can occur before birth, as the legs rotate to fit in the confined space of the womb. After birth, the legs should gradually rotate to align properly. Tibial torsion is present if the lower leg remains turned in. When the child begins walking, the feet turn inward because the tibia in the lower leg, just above the foot, points the foot inward. As the tibia grows taller, it usually untwists.

Femoral Torsion

Femoral torsion occurs when the child's thigh (femur) turns inward. It is often most obvious at about 5 or 6 years of age. The upper end of the thighbone, near the hip, has an increased twist, which allows the hip to turn inward more than it turns outward. This causes both the knees and the feet to point inward during walking. Children with this condition often sit in the "W" position, with their knees bent and their feet flared out behind them.

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Symptoms

Occasionally, severe intoeing may cause young children to stumble or trip as they catch their toes on other heel. Intoeing usually does not cause pain, nor does it lead to arthritis.

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Treatment

Intoeing will correct itself in a vast majority of children younger than 8 years of age without the use of casts, braces, surgery, or any special treatment. A child whose intoeing is associated with pain, swelling or a limp should be evaluated by an orthopaedist.

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Metatarsus Adductus

Metatarsus adductus improves by itself most of the time, usually over the first 4 to 6 months of life. Casts or special shoes used to treat a foot with a severe deformity or a foot that is very rigid has a high rate of success in babies aged 6 to 9 months. Surgical correction is seldom required.

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Tibial Torsion

Tibial torsion almost always improves without treatment, and usually before school age. Splints, special shoes, and exercise programs do not help. Surgery to re-set the bone may be done in a child who is at least 8 to10 years old and has a severe twist that causes significant walking problems.

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Increased Femoral Anteversion

Example of a child with intoeing secondary to increased femoral anteversion.

(Courtesy of Texas Scottish Rite Hospital for Children)

This is expected to spontaneously correct in almost all children as they grow older. Studies have found that special shoes, braces, and exercises do not help. Surgery is usually not considered unless the child is older than 9 or 10 years and has a severe deformity that causes tripping and an unsightly gait.

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Last reviewed and updated: August 2007

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.

Your Orthopaedic Connection
The American Academy of Orthopaedic Surgeons
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Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org