The Ins and Outs of Intoeing and Outoeing

Those of us who are parents know the feeling of obsessing over our little ones, making sure that they are always healthy, safe, happy, and well-cared for. It can be quite unsettling, then, to see strange patterns in your toddler’s gait when he or she starts taking her first steps—particularly feet that are turned in or out, known as intoeing and out-toeing.

The good news is that these conditions are quite common and most kids grow out of them in time. That said, should you still be concerned? Let’s look at both of these conditions a little more closely to find the answer.


Intoeing and Out-toeingAlso known as being “pigeon-toed,” this condition indicates feet that are pointed inward. The amount of rotation may be mild or severe, and symmetrical or asymmetrical, depending on the cause. There are three common causes for the condition:

  • Metatarsus Adductus: The most common congenital cause, it affects the feet only and is usually asymmetrical. In about 9 out of 10 cases, the issue corrects itself by age 1.
  • Internal Tibial Torsion: The most common cause overall of intoeing, it is also usually asymmetrical and features a rotation of the tibia. The knees point forward, while feet point inward. Most cases gradually improve and disappear by age 8 or sooner.
  • Femoral Anteversion: Similar to tibial torsion, except the femur (rather than tibia) is twisted, causing both knees and feet to turn in. Often diagnosed at around age 3-5, it peaks a few years later and usually disappears by age 9-10 or so.


Though less common than intoeing, the causes of out-toeing are very similar:

  • External Tibial Torsion: Broadly similar to internal tibial torsion, except the tibia is twisted outward. It usually emerges at around age 4-7 and typically resolves by age 10.
  • Femoral Retroversion: This typically becomes apparent in infancy just when your little one is starting to stand. It may get better on its own as your toddler learns to walk, but usually treatment is recommended if it is still present by age 3.
  • Flat Feet: Most young children have flexible arches that flatten when they stand, and that can cause feet to rotate outward. This is not a cause for concern unless the child is in pain.

Symptoms of Intoeing and Outoeing

Symptoms can vary depending on the cause and severity of the deformity. In many cases the problem is purely aesthetic, though significantly twisted limbs (especially with femoral rotation) may cause some stumbles and an unsteady gait.

Do I Need to Seek Treatment?

For the vast majority of causes and cases, the problem will correct itself in time, without any outside treatment. Furthermore, conservative measures like splints or braces tend not to be effective at correcting the deformity any faster. Most of the time, the only answer is to wait.

That said, rotated limbs are definitely something you want your doctor to keep an eye on—go for a checkup as soon as you notice a deformity, and return for follow-up as suggested. Although most cases are harmless, sometimes when symptoms are severe or the problem has not resolved by age 8 or later, further corrective treatments may be needed.

What is Treatment Like?

Treatment will depend on the precise cause of the condition, as well as severity. In some cases (especially infants with metatarsus adductus) special shoes or casting can be effective, though issues that involve twisting of the tibia or femur usually require surgery to reset the bone if the problem has not gone away by age 8-10.

It bears repeating: intoeing and out-toeing are common in childhood, and cases almost always get better on their own. It is a normal part of growing up.

That said, if you do notice anything, take your little one to visit Victoria L. Melhuish, DPM in Carson City or Gardnerville, NV for a check-up. Even though the condition is likely harmless, we want to make absolutely sure that you have nothing to worry about and that your child will grow up with healthy, sturdy legs and feet. Give us a call today at (775) 783-8037 to set up your appointment.

Photo Credit: Stuart Miles via