Toeing In and Toeing Out: Normal Gait Patterns in Kids

When children start out walking it is great fun to watch them—arms out for balance, feet twisting this way and that, toddling along until they plop down on their diapered bottoms. When they get a little older, you expect them to become more proficient, to straighten out their feet and walk in a straight line. If that doesn’t happen as soon as you think it should, you may start to get worried. We’re here to tell you not to worry so much. In-toeing and out-toeing are very common in young children and usually correct themselves by age 8 or so.

Gait Patterns in Children

Why Your Child Is Pigeon-toed or Toes Out

Other than the curving in of the feet at birth (metatarsus adductus), there are two main causes of in-toeing and out-toeing. The first is tibial torsion, which means your child’s leg is straight at the knee and above, but the lower part is twisted inward or outward, causing the feet to point to one side as well. The second is femoral torsion, in which the thigh bone twists to the inside or outside, meaning the rest of the leg and foot do, too.

It is important to remember that when they are little, this is not painful for children because their bones are still soft and flexible. It is also important to know that usually they outgrow this tendency for the leg bones to turn in or out, and the feet straighten on their own accord as your child’s muscles and bones get stronger and they learn to walk. Special shoes, braces, casts or stretching exercises don’t really help to hurry along the process when they are little.

Treatment for In-toeing and Out-toeing

Other than early straightening of feet with casting for metatarsus adductus, we will likely take a wait-and-see attitude with your child’s gait and simply monitor his or her progress. If your child can walk, run, and play normally without pain, no treatment is needed. Normally, children will outgrow most of these abnormal gait patterns by the time they are 6 to 8 years old. If your child does not, and has begun to have pain when walking and running, it may be time for more action.

Limbs can be corrected surgically if there are more than 50 – 80 degrees of rotation in the thigh and hip area. However, we will not recommend surgery until at least 8 to 10 years of age, and then only if there is pain, stumbling and falling, an awkward gait, or a limitation in their activity.

What Should I Do If I Notice My Child In-toeing or Out-toeing?

First, don’t panic. It may be a good idea to start a diary about when the gait was first noticed, any unusual injuries or infections, and your child’s walking and sitting habits and positions. These can be very helpful to us when trying to diagnose your child’s gait.

You should have us check your child’s feet and legs, just to rule out other possible conditions such as muscle or nerve diseases or an injury. Then partner with us through the months and years, continue the diary, and watch for any signs of pain. The abnormality should resolve on its own, but at least you have the reassurance that expert foot specialists are helping to monitor your child’s progress.

Call Aadvanced Foot Care Associates in New York for an appointment with our foot doctors. You can reach our Rego Park office at (718) 896-4433, our office in Flushing at (718) 969-2266, or our Plainview location at (516) 822-9595, or you may request an appointment online. If you have questions about your child’s foot development, call or contact us through our website. Now relax and enjoy your kids!


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Rego Park
97-07 63 Road
Rego Park, NY 11374
(718) 896-4433

100 Maneto Hill Road, Suite 103
Plainview, NY 11803
(516) 822-9595

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