In-toeing & Out-toeing

In-toeing and out-toeing describe the direction a child’s feet point when they walk.

• In-toeing means the feet point inward (pigeon-toed)
• Out-toeing means the feet point outward (duck-footed)

Both are very common in young children and are usually part of normal growth and development. In most cases, they improve on their own as children grow. When needed, evaluation and simple treatments can help support healthy walking and movement.

What Causes In-Toeing and Out-Toeing?

These walking patterns are usually driven by the way the bones are shaped and rotated during growth. Common causes include:

For in-toeing:

• Femoral anteversion (thigh bone turned inward)
• Tibial torsion (shin bone turned inward)
• Curved foot shape (metatarsus adductus)

For out-toeing:

• Femoral retroversion (thigh bone turned outward)
• External tibial torsion
• Flat feet
• Hip positioning differences

Most of these are normal variations that improve naturally with time.

What Are the Symptoms?

Many children have no pain or problems and are only noticed because of how they walk. Possible signs include:

• Feet that point inward or outward while walking
• Tripping or clumsiness, especially when running
• Uneven shoe wear
• Fatigue with long walks
• Rarely, pain in older children

When Should My Child See a Specialist?

You should consider seeing a pediatric orthopedic specialist if:

• The walking pattern is severe
• It does not improve with age
• Only one leg is affected
• Your child has pain or difficulty walking
• Your pediatrician has concerns

Early evaluation helps rule out uncommon but more serious conditions.

How Are In-Toeing and Out-Toeing Diagnosed?

Diagnosis begins with a physical exam and observing your child’s walk. The provider will assess:

• Hip rotation
• Leg alignment
• Foot shape
• Overall movement patterns

Imaging tests are rarely needed unless something unusual is found.

How Are In-Toeing and Out-Toeing Treated?

Treatment depends on:

• Your child’s age
• Severity of the walking pattern
• Whether symptoms are present

Treatment goals focus on:

• Supporting normal development
• Preventing discomfort
• Reassuring families when no treatment is needed

Nonsurgical Options

Most children need only observation and reassurance. In some cases:

• Physical therapy may help with balance and coordination
• Stretching exercises may be recommended
• Special shoes or braces are rarely needed

Modern studies show that most children improve without intervention.

Surgical Options

Surgery is rarely needed and is only considered if:

• The condition is severe
• It causes pain or functional problems
• It does not improve by late childhood

Surgery involves correcting the rotation of the bone and is reserved for special cases.

What Does Recovery From Treatment Involve?

Most children require no treatment and continue normal activities.

If surgery is ever needed, recovery includes:

• Temporary activity restrictions
• Physical therapy
• Gradual return to full movement

How Long Does It Take to Improve?

Most in-toeing and out-toeing patterns improve gradually over several years as children grow and develop stronger muscles and better coordination.

What Is the Outlook for My Child?

The outlook is excellent. The vast majority of children outgrow in-toeing and out-toeing and go on to walk, run, and play without any long-term problems.

Care at Columbia

At Columbia Orthopedics, we carefully evaluate walking patterns and support families with clear guidance and reassurance. We offer:

• Pediatric orthopedic specialists experienced in gait and alignment conditions
• Thorough physical evaluations to determine normal vs. concerning patterns
• Observation and reassurance
• Treatment only when necessary
• Long-term monitoring as your child grows
• Personalized care focused on healthy movement and development

If you have concerns about your child’s walking pattern, contact Columbia Orthopedics today. We’re here to support your child’s growth and confidence with every step.