Kids grow and change so rapidly, and it can be hard to know what’s completely normal and what can be a sign of something being not so normal. We have many parents who brings their kids in to show us things they have noticed in regard to the way their kids walk & stand, and different characteristics are normal for different ages and and stages of development.
In-toeing may also be referred to as pigeon-toeing. This can be distinguished by seeing your kids walking with their toes pointed inwards. In the early years of life, up to 3 or 4 years old, in-toeing is not an abnormal occurrence. In the early years, it’s just a part of the development process for those that experience it and is not a cause for concern if there is no pain or discomfort associated with it. There are actually three primary causes of in-toeing, these are:
- Metatarsus Adductus – Metatarsus Adductus is the most common cause of in-toeing at birth and in toddlers. It describes a kidney-like shape of the foot itself where the front half of the foot bends inwards.
- Internal Tibial Torsion – Internal tibial torsion describes an inward (toward the centre of your body) twisting of the tibia (shin bone) that leads to in-toeing. It is the most common cause of in-toeing from when kids begin to walk until 4 or so years of age.
- Femoral Anteversion – This describes an inwardly rotated position of the femur that results in the whole lower limb being turned inwards, including the feet and even the kneecaps. This is one of the reasons that kids are discouraged from sitting in a W position as it encourages the rotation of the femur.
Out-toeing is less common than in-toeing and essentially has the opposite causes to in-toeing. If not present at birth, it tends to occur later in childhood, but usually resolves by the age of 7. If out-toeing (or in-toeing) persists past this age, it is a good idea to get the feet and legs checked by your Podiatrist. If out-toeing is paired with pain, discomfort or regular tripping/falling, we recommend you bring your child in sooner. Causes of out-toeing can include:
- External Tibial Torsion – Opposite to internal tibial torsion, external torsion describes the outwards twisting of the shin bone that leads to the foot moving outwards. It is often seen between 4 and 7 years of age, and kids may go from a period of in-toeing to a period of out-toeing before the legs straighten up.
- Femoral Retroversion – This describes an externally rotated position of the femur (thigh bone) at the hip joint. It occurs due to the position of a fetus in the womb and should be evident when a child stands, even before they begin to walk.
Changes Over Time
As kids grow older, we expect to see them go through various developmental changes in the bones, joints, muscles and ligaments of their feet and legs. As we mentioned, legs may be internally rotated about to 3 or 4 years of age, they may be externally rotated up to 7 years of age, and then should straighten up and be in a normal, healthy position. These changes occur as kids learn to walk, become stronger and improve their posture and balance.
There are some cases where in-toeing and out-toeing can be problematic. If your child’s foot position is having a negative impact on their lives, we recommend that you bring them in for an assessment. You may notice:
- Pain or aches
- Regular tripping or falling
- Inability to keep up with kids their own age
- Unwillingness to participate in physical activity (likely because of any of the above)
What Should You Do?
If your child is experiencing symptoms, then there are absolutely things that can be done to help their development and encourage healthy alignment of the feet and legs. This can involve strengthening and/or stretching activities and exercises, footwear advice, orthotics and in extreme cases, bracing. Your Podiatrist will determine the right path for your little one after a thorough assessment of their feet and legs, as well as identifying the exact cause of their foot abnormality.
We are parents of young children too so know how distressing it can be to see kids in pain or with abnormalities and be unsure of the right course of action to take. We make it simple, easy and pain-free to bring your kids in and get their feet checked. Where treatment is not required or recommended, we will track progress over time with annual checks to ensure your kids remain happy, healthy and on track to success.