In-toeing in Children: Causes, Assessment & Treatment in Whitby
We assess and treat in‑toeing in children at our Whitby clinic. In‑toeing (“pigeon toes”) is common and usually improves naturally as a child grows. Some children experience tripping, fatigue, or difficulty fitting shoes, and a small percentage require treatment. Our chiropodists provide a full biomechanical assessment to determine the cause and recommend appropriate management.
What is in-toeing?
In‑toeing describes a walking pattern where the feet point inward instead of straight ahead. It occurs in about 2 out of every 1000 children and is usually due to a delay in normal rotational development of the legs and feet. Most children gradually self‑correct as they grow.
Is in-toeing serious?
In‑toeing describes a walking pattern where the feet point inward instead of straight ahead. It occurs in about 2 out of every 1000 children and is usually due to a delay in normal rotational development of the legs and feet. Most children gradually self‑correct as they grow.
Causes of In‑toeing
There are three main causes of in‑toeing in healthy children:
1. Internal Femoral Torsion (Femoral Anteversion)
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- Inward twist of the thigh bone
- Often noticed between ages 2–6
- More common in girls
- Children often sit in a “W” position
- Usually resolves by age 6–8
2. Internal Tibial Torsion
- Inward twist of the shin bone
- Often noticed when a child begins walking
- Usually improves by age 6–8
- Most common cause of in‑toeing overall
3. Metatarsus Adductus
- Forefoot curves inward (kidney‑bean shape)
- Often present at birth
- 90% resolve naturally
- Severe cases may require stretching, splints, or casting in infancy
How We Assess In‑toeing
Assessment includes:
- Six rotational measurements of the hips, legs, and feet
- Gait analysis
- Observation of kneecap position
- Evaluation of sitting and standing posture
- Identifying which of the three causes is present
Treatment Options for In‑toeing
Observation & Reassurance
Most children require no treatment. In‑toeing almost always improves naturally as the child grows. Parents are reassured that their child will lead a normal, active life.
Gait Plates
If tripping is a concern, gait plates can help encourage an out‑toed walking pattern in older children.
Avoiding the “W” Sitting Position
Recommended for children with femoral anteversion.
Stretching, Splints, or Casting (for Metatarsus Adductus)
Used only when the forefoot is not flexible.
Surgery (Rare)
Reserved for severe, persistent torsional deformities that do not improve by adolescence.
When to Seek Treatment
Parents should book an assessment if:
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Tripping is frequent
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Shoe fitting is difficult
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The child complains of fatigue
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The in‑toeing appears severe
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Only one leg is affected
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The child is older than 8 and still in‑toeing
In‑toeing Treatment in Whitby
We provide full pediatric gait assessment, measurement of rotational alignment, and treatment recommendations tailored to your child’s age and cause of in‑toeing.