In-toeing in Children: How common is it?

Most children learn to walk with their feet pointing straight ahead, however, when they walk with their feet pointed inward, this is called in-toeing, or pigeon-toed. According to Columbia Orthopedics, 2 out of every 1,000 children will in-toe. In-toeing affects boys and girls equally, and is often noted to both

There are 3 main causes of in-toeing:

  1. Femoral anteversion: A condition where the hip turns in.
  2. Tibial torsion: Where the lower leg turns (shin bone) in when compared to the upper leg.
  3. Metatarsus adductus: The bones in the foot turn in.

The most common cause of femoral anteversion is tibial torsion. Tibial torsion usually starts in-utero and disappears by the time the child is 5 or 6 years old. Femoral anteversion can also be started in-utero, and is usually corrected by age 9 or 10. Most of the time, in-toeing corrects itself with no intervention. Special shoes and braces used to be quite common in treating femoral anteversion, however, these have been proven to not be helpful in treating in-toeing.

Most of the time, in-toeing does not cause any problems with sports or leading a normal, healthy lifestyle. It has not been proven to cause arthritis in life, which is a common mis-conception. However, some children fall or trip more often when they are younger secondary to in-toeing. Physical therapy can help with balance reactions, safety awareness and strengthening to decrease the tripping and falling and help promote proper alignment.

If you are worried about your child’s in-toeing, or suspect that it is getting worse, talk with you pediatrician or contact a licensed pediatric physical therapist.


References: The Children’s Hospital at Westmead

Columbia Orthopedics, New York Presbyterian

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