Better Care

What every parent should know about in-toeing

Advice for parents

Small children may in-toe as they are growing up. It is really a part of growing up for many toddlers. There is nothing to worry about, and as they get older it will go away. Some children in-toe because there is a twist to the bones in their leg, either in the:

When the twist is in the foot it is called metatarsus varus. Often this can be helped by applying casts to the small child. The casts are changed every week or two gradually straightening the foot. After about 6 weeks the foot is usually straight; special shoes may be needed for a few months afterwards to keep the foot straight.

When the twist is below the knee, it is called internal tibial  torsion. This is something which is made worse by a child sleeping face down, with the feet turned in underneath, or by a child sitting on his feet habitually. For many children just stopping these habits is enough to allow the condition to get better by itself.

Some children in-toe because there is a twist between the knee and the hip. This is internal femoral torsion. It is more common in girls than in boys.

Some girls are born with a tendency to this, and they find it very easy to sit in the ‘W’ position, which aggravates the condition and prevents it from getting better by itself. For some girls, stopping sitting like this will be enough.

For more than fifty years, people have been using different kinds of braces and splints and special shoes and special exercises in an attempt to overcome internal femoral torsion. All the studies show that this equipment makes no difference, and it cannot be recommended.

Most children show a tendency to improve until the age of eight or ten, after which things remain stationary. For the five per cent of children who do not improve enough by the age of ten, there remains the possibility of correction by an operation.

However, this is hardly ever needed in practice. We do not do the operation at a younger age than ten, because we find that most children grow out of the problem on their own. Remember that many track stars have a little in-toeing, and this seems to be a factor in their success. Remember that in-toeing does not cause arthritis.