Learning to walk is a huge milestone in every child’s life. Parents cheer on children as they discover how to balance and figure out how to use their feet. Since learning to walk properly is such an important part of human development, noticing gait abnormalities like intoeing or out-toeing can be very disconcerting.
Taking Baby Steps
Baby steps normally do not look like adult steps. It takes several years for a child’s walking mechanics to become recognizably stable and adult-like. Their feet start small and flat. Babies and toddlers tend to stand with their feet wide apart and take many rapid, short steps. They bring their feet up high to take a step and may keep their arms out for balance. Developing enough coordination to run or suddenly change direction doesn’t happen until after age two. Even so, issues like intoeing and out-toeing can make even a baby’s naturally uncoordinated gait look even more unusual.
Why Your Child’s Toes Don’t Point Straight
Intoeing and out-toeing may look abnormal, but they are actually fairly common in small children. Both conditions have several different causes:
Intoeing – For this condition, your child’s toes appear to point inward toward each other when he or she stands or walks. Typically this results from one of three underlying issues: metatarsus adductus, tibial torsion, or femoral anteversion. Metatarsus adductus is a curve in the feet through the midfoot. It’s obvious from birth. Tibial torsion is a slight inward twist in the shin bones, which may not be noticeable until your child is learning to walk. Femoral anteversion is a slight rotation in the thigh bone, which is most visible during the early walking years up until school age. These three conditions usually develop because of the way your child was positioned in the womb.
Out-toeing – With this condition, your child’s toes appear to point outward when he or she stands or walks. This is significantly rarer than intoeing, but it does happen. Usually this is the result of a slight twist at the hips caused by your child’s position in the womb. The issue is most obvious by age one. Sometimes it’s the result of slight twists in the shin bone or thigh bone, too. Occasionally, out-toeing can also be associated with a few neuromuscular disorders.
What to Expect for Treatment
In most cases, your child probably won’t need much in the way of treatment. Both of these gait abnormalities usually resolve on their own after a few years. Braces, special shoes, and physical therapy might be helpful for metatarsus adductus, but they do nothing for the other causes of intoeing and out-toeing. Still, you should have your child’s lower limbs and walking evaluated.
Dr. Brandon S. Percival, Dr. Julie A. Percival, and Dr. William Harris will carefully examine your child’s gait and lower limbs to determine the underlying problem. Since out-toeing can sometimes be linked to neuromuscular disorders, an evaluation is important. If your child doesn’t appear to have any other health problems, our team will decide what, if any, treatment will benefit his or her walking ability. If your child is still very young, the abnormal walking doesn’t cause tripping or pain, and results from twists in the leg bones, we will most likely simply monitor your child’s growth and gait.
For metatarsus adductus that isn’t resolving, we may recommend a course of stretching and casting. This treatment is similar to that for clubfoot. Your infant’s feet will be gently stretched into place, then put into casts or special shoes to hold them there while they grow into the correct position. If your child’s intoeing or out-toeing does cause pain, difficulty walking, or lasts past age ten, your child may need more invasive treatments to address the issues in the bones.
While it’s concerning to see your child walking funny, you may not have to worry after all. Let our team at Carolina Podiatry Group help monitor your child’s gait and growth to make sure she or he develops normally. Just contact either of our South Carolina offices for an appointment today: (803) 548-FEET for Indian Land or (803) 285-1411 for Lancaster.