Gait abnormalities are very common in children. As their bodies develop they may experience some difficulties walking in a normal fashion. Two of the most commonly seen problems are in-toeing and out-toeing. These will typically resolve themselves spontaneously with no cause for concern, but what if they don’t?
What is In-toeing?
In-toeing in children refers to the feet pointing inwards instead of straight ahead. This is also known as being “pigeon toed.” In-toeing is not usually something to be worried about and will most likely correct itself. Your child may not have any pain associated with this symptom, but it may make them more likely to trip when they are walking or running.
Having an in-toed gait is a product of other conditions. For instance, tibial torsion can occur when your child is in the womb. It simply means that their legs were most likely in a confined position and never turned out once they were born. There is no “treatment” as splints and special shoes will not help. This will likely correct by age 4. If your child is bow-legged they may also develop pigeon toes. The only time to ever consider surgery for in-toeing is by age 9 or 10 and only if they are constantly tripping and falling.
What is Out-toeing?
Out-toeing is when the feet look as if they are pointing outward. It can also be the side effect of an underlying condition.
One reason out-toeing can occur is because of flat feet. Flatfoot is very common in children. It is usually not painful and will resolve on its own. Another cause is external tibial torsion, which is an extreme twisting of the knee in late childhood. There may be pain associated with this condition, usually in the knee. Hip contracture is another condition that is usually accompanied with out-toeing. This is when, after birth, the hips remain tight. It will often correct itself with no cause for worry.
Footwear, braces, physical therapy, and other forms of treatment will do nothing to help improve out-toeing. In extreme cases where pain is involved, we may recommend surgery.
When Should I Get My Child Evaluated?
We know that it’s only natural to worry about your children. You can always speak with a doctor about any concerns you may have. However, here are some things to keep in mind.
Remember that your child will probably only outgrow their gait abnormality by age 3 at the earliest. Have them looked at if they don’t spontaneously resolve by then. You should also have them evaluated if they are complaining of pain or discomfort, if there are developmental delays elsewhere (such as learning to speak), or if their condition worsens instead of improves. Out-toeing can possibly be the result of a neurological disorder so it’s best to rule that out first.
Getting Medical Help from a Podiatrist
If you have more questions or concerns about in-toeing and out-toeing, call Dr. Mitchell Wachtel at (978) 794-8406 to schedule an appointment at one of our three Massachusetts office locations. We are here to help treat your entire family and put your mind at ease. Most of the time these issues will correct themselves, but we can offer you the best treatment possible if they don’t.