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Next Step Foot & Ankle Clinic

In-Toeing and Out-Toeing: Learning How to Walk

It takes children time to learn how to walk. They wobble and stumble as they figure out how to balance and propel themselves forward. Even when they master the mechanic, they don’t walk quite like adults. However, some walking patterns aren’t normal, even for kids. Gait abnormalities like intoeing and out-toeing are common issues that are usually monitored to ensure they don’t cause walking difficulties.

intoeing and outtoeingToes Pointing the Wrong Directions

Intoeing and out-toeing are gait abnormalities that arise when toes don’t point straight forward when the child stands. The result matches the name: intoeing is a problem with the toes appearing turned inward, while out-toeing shows the digits pointing outward. Multiple lower limb issues can lead to each of these. How seriously either affects your child’s feet can vary. In the majority of cases, neither condition impairs your son or daughter’s ability to learn to walk. Other times, however, it can trip up your child.

Digits Turned In

Intoeing is one of the most common gait abnormalities in children. It can have several different causes. Metatarsus adductus, tibial torsion, and femoral torsion are the main culprits for digits that appear to point inward. Metatarsus adductus is a birth defect, where a baby’s feet curve inward at the middle of the arch. Tibial torsion is a slight twist in the shin bone that rotates the feet inward and is most visible in early childhood. Femoral torsion is an inward twist of the thigh bone and can be seen best when your son or daughter is about school-aged.

Digits Turned Out

Out-toeing is a fairly uncommon gait issue for children, but it does happen and can be the result of a couple different causes. Usually it’s an issue with an outward rotation at the hip. This situation typically resolves on its own shortly after your child begins walking. However, outward-pointing toes can also be caused by rotations in the shin or thigh bones. This is unusual in healthy children and is more likely to be a symptom of a serious neuromuscular disorder.

What to Do for Children’s Feet

Dr. Darren Silvester and our staff at Next Step Foot & Ankle Clinic will need to evaluate your child’s lower limbs to determine the extent of the gait abnormality and how significantly it’s affecting your son or daughter’s ability to walk. We will also look for underlying issues like neuromuscular disorders that may be connected to the problem. From there we can decide what action, if any, is needed to manage the condition.

For many of the underlying causes for intoeing and out-toeing, active measures like splints and special shoes to correct the toes’ position don’t make much of a difference. They normally fix themselves on their own as your child grows and his or her muscles and bones develop. General children’s foot care should be enough to maintain healthy lower limbs.

In the case of metatarsus adductus there may need to be some stretching or casting—similar to the treatment used for clubfoot—if the condition lasts longer than a few months or is particularly severe. For rotations in the shin or thigh bones, surgery may be an option when your child is over the age of ten and the rotation makes walking difficult or otherwise bothersome. If either condition is connected to neuromuscular diseases, the underlying problem will need its own treatment.

You don’t need to be concerned about the way your child’s toes point when he or she is learning to walk. You should have the condition monitored, though, particularly if it interferes with normal walking for your son or daughter. Dr. Darren Silvester and our team at Next Step Foot & Ankle Clinic can help. Contact our Universal City or Pleasanton, TX, office for more information. Use the website or call 210.375.3318 to reach us.