In-Toeing

The majority of children's feet point straight ahead or slightly outward. Children whose feet point inward are said to have "in-toeing" or be "pigeon toed". In the vast majority of children, in-toeing will go away without any treatment. In the past braces were used to treat in-toeing; however, recent studies have shown that braces offer no advantages and do not alter the natural history of resolution over time in most cases. The usual progression of rotational growth in the lower extremity leads to correction of most cases of in-toeing by age 6 to 8.

In a small percentage of children, the in-toeing does not completely resolve; however, most of these children will cope just without any difficulties in their activities of daily living. Rarely does a child with unresolved in-toeing need surgical treatment to correct the problem. There is no evidence that in-toeing leads to arthritis or causes clumsiness. In fact, many of our best track and field athletes are pigeon toed. Occasionally, in-toeing may cause problems with shoe-wear, but braces, or inserts do not correct the problem.


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Out-Toeing

Out-Toeing is much less common that in-toeing. The most typical presentation is within the first or second year of life. Most children are born with external rotation contractures of the hips and this solves shortly after walking begins. In those children in whom the resolution is slower, out-toeing is the result when they first start walking. This will almost always resolve within a year from the onset of walking.

Out-Toeing may also be caused by outward twisting of the tibia or femur bone, and is not usually seen in normal children, but is more common in those with the neuromuscular abnormalities. As with in-toeing, custom made foot orthotics for kids, bracing and shoewear are helpful in resolving the deformity. Occasionally, a normal child will have out-toeing from tibial or femoral outward twisting that does not resolve by the end of the first decade and that may cause functional difficulties. If this is the case, custom made foot orthotics and orthopedic foot wear can help prevent adult hood problems.