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Inward twisting of the shinbone (internal tibial torsion) is one of the most common causes of intoeing.

The cause of intoeing could be a problem with a child's feet,  legs, or thighs. Inward twisting of the shinbone (internal tibial torsion) is one of the most common causes of intoeing.

Pediatric intoeing can be caused by one or a combination of conditions that are described below.

• Each of these conditions has the potential to run in families.
• Determine when you first noticed that your child's feet and/or gait are different before making an appointment with a doctor.
• The age of onset provides important clues to the underlying issue.

You should disclose any history of neurological issues or missed developmental milestones. Don't forget to include any complications that occurred during pregnancy and delivery. Your child’s medical history from conception to the present is critical for obtaining an accurate picture of their current health.

At birth

The most likely diagnoses if you notice an abnormality in your child's feet at birth include:

1. Hallux varus:
   • The big toe is affected by this condition, causing it to turn inward or medially.
2. Metatarsus adductus:
   • It refers to the curving of the feet that causes them to bend inward from the middle part of the feet to the toes.
   • Severity varies from feet that can be placed into a normal position to feet that are not flexible.
3. Talipes equinovarus or clubfoot:
   • It is caused by shortened connective tissue between the muscles and bones.
   • As a result, the foot sits at a sharp inward angle.
   • This congenital condition should be treated as soon as possible so that it does not limit mobility.
4. Cavus deformity:
   • This foot deformity is distinguished by an extremely high arch, which usually indicates the presence of a neurological condition.

Toddler and school-age children

1. Tibial torsion:
   • The tibia, or shinbone, can turn inward.
   • This cause may not be discovered until a child begins to walk.
2. Femoral anteversion:
   • Even after your child starts school, you should keep an eye out for changes in their gait.
   • The femur, also known as the thighbone, can twist inward and cause problems.
   • In addition to the thigh, the knee turns inward.
   • If your child frequently sits in the “W” position, you should be on the lookout for signs of this condition.

Other factors that may cause intoeing in combination with the above include:

• Genetics
• Poor postural positions
• Tight muscles
• Low muscle tone
• Injury

Because these are hereditary, prevention is usually not an option. These conditions frequently improve as children grow, but in more severe cases, early intervention is critical to reducing the amount of deformity that may cause pain and concerns later in life.

How is intoeing diagnosed?

The diagnosis of intoeing may apply to a child’s feet and their lower or upper legs:

1. The feet:
   • The front of the foot curves inward, and the foot as a whole is completely flexible.
   • This may be noticeable at birth or in the first few months.
   • It can affect either one or both feet and is most likely caused by your baby's position in the uterus.
   • When a child's foot is turned inward, this is referred to as metatarsus adductus.
   • Compared with the hindfoot, the forefoot is adducted or curved inward.
   • This gives the foot a “banana” or curved shape and will most likely result in an intoeing gait when a child walks.
2. The lower legs:
   • Excessive inward twist of the shinbone (tibia) relative to the knee joint may cause intoeing. This becomes apparent when the child begins to walk.
   • The cause is most likely due to your baby's position in the uterus.
   • Internal tibial torsion is another name for this condition.
3. The upper legs:
   • The thighbone (femur) is twisted excessively, causing the entire lower leg to turn inward relative to the hip joint.
   • It is more common in children aged three to six years. Femoral anteversion is another name for this condition.

All ___________ have flat feet.
See Answer

What are your child symptoms for intoeing?

Intoeing, also known as pigeon toe, is a condition in which the feet point inward instead of straight ahead when walking.

• It is frequently noticed by parents when their child begins to walk, but children of all ages can exhibit intoeing for various reasons.
• It usually does not cause pain or arthritis, and it usually goes away on its own in very early childhood with no treatment or intervention.

Signs or symptoms may include:

• Frequent tripping/falling and clumsiness
• Difficulty with shoes
• Difficulty progressing from walking to running
• Half-moon-shaped feet

Although intoeing is usually asymptomatic, it can be a source of embarrassment for the child, leading to low self-esteem and affecting their participation in activities.

An orthopedic surgeon should evaluate children who have intoeing that is accompanied by pain and swelling.

Is intoeing a treatable condition?

Intoeing is a problem that frequently resolves itself without the need for correction. As children grow, their toes begin to turn in the right direction. Podiatrists are specialists in the treatment of foot problems, such as intoeing.

Treatment outcomes for pediatric intoeing are better when treated early, and sometimes, only parent assurance and education are required.

Podiatry treatment options for children with intoeing include:

• Addressing postural issues
• Children’s orthotics including gait plates
• Stretching and strengthening
• Casting
• Physical therapy

Although most cases of children's intoeing resolve spontaneously, other cases may persist or worsen if the underlying cause is not addressed, so an evaluation with a podiatrist is required.

If the condition does not improve as the child grows, surgery may be the only option for treatment. Surgery is generally performed only when your child is aged 8 to 10 years and has significant problems walking.