Normally, feet point outward, but children who have a condition known as intoeing have inwardly pointed feet. Intoeing does not typically lead to serious long-term problems and usually resolves on its own. If an improvement does not occur, treatment may be needed to correct the problem.

Causes

Intoeing can be caused by a number of conditions:

• Metatarsus Adductus: Metatarsus adductus is an inward curve in the child’s foot. It is noticeable immediately after birth and occurs when the child’s legs are pressed in a curved position before birth. The curve is most apparent when examining the sole of an infant’s foot. In approximately 9 of 10 children, the feet straighten as the infant develops during the first year of life. Although medical experts disagree about how long treatment should be delayed, many believe a casting or bracing procedure should be instituted when the child is between 4 and 6 months old and concluded by the time the child reaches normal walking age.

• Internal Tibia Torsion: An inward twist of the leg bone between the ankle and knee. Internal tibia torsion becomes evident when the child begins to walk with toes pointed inwardly during the second year of life. In most children, the condition resolves itself without treatment between ages of 4 and 6.

• Femoral Anteversion: If an inward twist is present in the upper thigh bone at the hip, the condition is known as femoral anteversion. Femoral anteversion is seen in children between the ages of 2 and 4. Like foot and knee problems visible at younger ages, femoral anteversion is caused by a cramped positioning before birth. Most cases correct themselves without treatment between ages 6 and 8.

The condition usually develops during the last trimester of pregnancy and is directly related to the intrauterine position of the developing fetus.

Diagnosis

Diagnosis normally occurs during routine physical examinations of the child.

Five measurements are used to create a torsional profile (a composite measurement of the lower extremities) and determine if intoeing is present: the foot progression angle, the thigh-foot angle, the hip internal rotation, the hip external rotation, and the heel bisector line.

The measurements normally occur in a physician’s office with the child in a prone position, hips fully extended, and knees flexed at a 90-degree angle.

Treatment

If the cause of intoeing is metatarsus adductus and the curving of the feet does not go away after stretching, serial casts can be employed. The casting progresses until the lateral border of the foot moves to a straight position.

In children with internal tibia torsion, a bar with shoes attached to it can be used to make the child’s feet turn outward gradually. The success rate of this method is moderate, and children may not cooperate because the device is awkward and uncomfortable. If appearance becomes an issue for parents, surgery can be an option; although this is rarely done. Surgery involves cutting the bones and rotating them out to make them look straight.

Because femoral anteversion tends to go away between the ages of 6 and 8, surgery is generally a last resort performed after age 8. The surgery requires cutting the thighbone and twisting it outward so the feet will point straight ahead.

Calling a Specialist

Because intoeing gradually resolves as the child grows, consultation rather than direct action is often the best choice. Specialists recommend video recording the child’s gait every year to look for improvement. If the child continues to exhibit intoeing after the age of 8, active treatment should be considered.