1. family and parenting
2. children

Surgical correction is not even considered at
a young age since most children show complete correction on their own.
Some children find it easy to sit in the ‘W’ position between their heels.
The Hip: (tight hamstring muscles)
Podiatry Department
Tight hamstrings (muscles at the back of the
thigh) can also cause the appearance of an
intoed gait with the kneecaps turned inward.
Sitting and sleeping positions can aggravate
this and growth spurts often make the intoe
seem much worse.
Usually a set of stretching exercises, performed regularly, will be enough to see improvement.
General Advice
Intoeing will not affect a child’s ability to
walk, run, play and enjoy normal childhood
activities.
It should get better with time not get worse.
Intoeing in Children:
It may delay the natural correction that occurs
with growth and development and should be
discouraged.
Sitting with legs crossed should be encouraged instead.
If you are concerned seek an assessment
from the podiatry department.
Review Date: 31/03/2012
Braces and special shoes are not needed,
research has not proven their effectiveness
in treating this condition; however orthotic
insoles, called gait-plates, may improve the
appearance of intoeing.
Surgical correction is rarely needed and
never considered in children until they have
stopped growing.
Activities that encourage an out-toed position (such as ballet) can help, as can kicking a ball and jumping on a trampoline.
Walking like a penguin with heels on the
ground, toes in the air, and with feet pointed
out can help.
Biomechanics Clinic
Podiatry Department
Leander Road Primary Care Centre
949 London Road
Thornton Heath
CR7 6JE
Phone: 0208 274 6820 / 6836
Fax: 0208 274 6833
a guide for parents and
carers.
What is intoeing?
Intoeing is the name used to describe walking with the feet turned in towards each other, often called pigeon toed gait.
Intoeing is a normal variation in the development of gait.
It is estimated to be present in 40% of children and 4% of adults, and most who intoe
will grow out of it by the age of 8 without any
treatment.
Intoeing in those without neurological problems may be caused the position of the foot,
the knee or the hip, or sometimes a combination.
The Foot: (metatarsus adductus)
This is an inward curve of the foot.
It is most easily seen if you look at the sole of
your child's foot, shown in the pictures below.
If intoeing is asymmetrical or unilateral or
combined with toe walking on one side it is
best to seek a referral for assessment
The feet may have been pressed into this position inside the womb, before birth.
What causes intoeing?
If the feet can be gently stretched into the
correct position no treatment should be needed.
It is related to the inter-uterine position, and
adopting sitting and walking postures that
maintain the position.
There are links between family history, walking ‘early’ and the use of baby-walkers.
Intoeing can be due to tight muscles or lax
(weak) ligaments.
Intoeing may be neurological in origin and is
present in greater than 60% of those with
diagnosed with Cerebral Palsy.
It is more noticeable if
there is hypermobility
(increased movement
due to weaker ligaments) in the joints.
The Hip: (internal femoral torsion)
It is usually seen in both feet but can occur,
or be more noticeable, in one leg.
Intoeing may originate from a single cause
or multiple factors, and often appears worse
if the child is tired.
Younger children walk
with a ‘bent-knee’ and
this exaggerates the
appearance of the
intoed position. It is often worse aged 2-3 and
improves by 4-5 yrs.
If the foot is stiffer before the child walks then
stretches, splinting or serial-casting may be of
benefit.
A strong curve can cause problems with fitting shoes, and this is the main reason for
treatment.
The Knee: (internal tibial torsion)
This is when the knees face forwards and the
feet point inwards, because of an increased
twist in the tibia (shin bones).
This can also be caused by the position of the
baby in the womb.
The femur (thigh bone) has a natural inward
twist called ante-version, this gradually
‘unwinds’ during normal development.
If the unwinding takes longer than normal the
whole leg can appear internally rotated, so
the knees and toes both face inwards.
In 90% of cases the intoeing will slowly improve between the ages of 7 and 14. In persistent cases there is
usually a strong family
history.
For the rare case that
does not improve,
there remains the possibility of correction by
an operation.