Intoeing and outtoeing

Intoeing is when the feet point inward instead of straight, and is often called being "pigeon toed." Outtoeing means the feet point outward instead of straight, a condition often called "duck feet."

Both conditions:

  • May run in the family (genetic)
  • May be caused by the baby's position in the uterus
  • Are common in young children
  • Rarely need treatment since most children outgrow it
  • Will not affect your child's ability to walk, run or play

Sometimes severe intoeing can cause a young child to trip and fall. Falling often comes with learning to walk, so it may not be caused by intoeing. If your child has intoeing or outtoeing along with severe pain, swelling or a limp, he or she should be seen by an orthopedic provider.

What causes intoeing?

There are three reasons children may have intoeing. The conditions can occur on their own or with other bone and muscle problems so cannot be prevented. There may be a family history.

1. Metatarsus Adductus (curved foot): This is the most common cause of intoeing in infants. Most infants are born with this condition. There are two types of MTA:.

  • Flexible MTA: This is common, and will often improve or go away on its own during the first four to six months of life with no impact on a child's ability to walk. Sometimes casting can be used to help the foot grow straight.
  • Stiff MTA: If the foot is stiff, the provider may recommend a cast, which will stretch the foot so it can grow straight. The cast is changed as the child's foot changes. If casting is done, special shoes may be needed to help maintain the corrected MTA. Surgery for metatarsus adductus is rare.

2. Internal tibial torsion (twisted shin): This occurs when a child's lower leg (tibia) twists inward. It can occur before birth as the legs rotate to fit in the confined space of the womb. After birth, an infant's legs should gradually rotate to align properly, but if the lower leg remains turned in, the result is tibial torsion.

This condition almost always improves without treatment, and usually before school age. Splints, special shoes and exercises do not help, and surgery to reset the bone would only be done in children 8 to 10 years old who have a severe twist that causes severe problems with walking.

3. Femoral anteversion (twisted thighbone): This occurs when a child's thighbone (femur) turns inward, and is most noticeable around ages 5 and 6. The upper end of the thighbone has an increased twist, which allows the hip to turn inward more than it turns outward, causing both the knees and feet to point inward during walking.

Femoral anteversion eventually corrects itself in almost all children. Special shoes, braces and exercises have not been found to help, and surgery is generally not considered unless the child is older than 10 and has a severe deformity that causes tripping or an unsightly gait

What causes outtoeing?

This is much less common than intoeing, but it may lead to pain and disability as the child grows. The causes of outtoeing are often the reverse of what causes intoeing, and include:

  • External tibial torsion: This outward twising of the leg bone is usually seen in late childhood or early adolescence, and usually affects only one leg.
  • Hip contracture: Babies are born with their hips externally rotated, and hip contracture occurs when the hips don't move during gestation and are constrained in this position after birth. This condition resolves on its own without treatment.
  • Femoral retroversion: This occurs when the thighbone is angled backward relative to the hip joint, which can cause the entire lower leg to turn to the outside. This is most often seen in obese children and could predispose them to early arthritis or another childhood hip condition called slipped capital femoral epiphysis (SCFE).
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