In-toeing is a type of standing posture or gait pattern in which a child’s feet, and in some cases the entire leg, point in toward each other while the child is standing and/or walking. These children are sometimes referred to as being “pigeon toed.”
In-toeing can be a normal part of development. In typically developing children, there are three causes of in-toeing:
In-toeing caused by the upper part of the leg (the femur) and hip
In-toeing caused by the lower part of the leg (the tibia)
In-toeing caused by the shape of the foot
In some children, in-toeing can be caused by other conditions, such as developmental hip dysplasia, club foot, cerebral palsy, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, or other neurological conditions. It is important to let your pediatrician know your concerns about your child’s in-toeing so they can make sure it is not being caused by something other than normal development.
In-toeing caused by parts of the leg:
More than 80 percent of in-toeing cases caused by the upper or lower parts of the leg resolve on their own by 8 to 10 years of age. Rarely does this in-toeing persist to cause significant functional problems with walking, running, jumping, etc. There has been speculation that excessive in-toeing may cause degenerative arthritis of the hip and/or back, but this has been found to not be true.
Even though in-toeing typically resolves on its own, parents may still be concerned about this standing and walking pattern. Observing your child’s legs and the way they walk is truly the best treatment strategy for your child. Physical therapy treatment is unable to change the structure or curve of a bone in children who are typically developing. Bracing and shoe modifications for children who in-toe are unnecessary and are discouraged. There is no evidence that these will change the natural history of in-toeing or speed up the process.
In-toeing caused by the shape of the foot:
This type of in-toeing spontaneously resolves in 85-90 percent of cases by the time an infant is 12 months old. A pediatrician or physical therapist can evaluate a child with to determine if the case is mild, moderate or severe. Infants with mild or moderate in-toeing caused by the shape of the foot can be treated with stretching exercises at every diaper change. If an infant has a severe case, they will be referred to a physician specializing in orthopedics for treatment.
If you have concerns about your child’s in-toeing, consult with a physical therapist who can give you advice and direction.
Jessica Brock, PT, DPT, PCS is a developmental pediatric physical therapist in the outpatient physical therapy department. She completed a post-doctoral pediatric residency program at The Ohio State University.
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