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In-Toeing & Out-Toeing In Toddlers - Find Out Everything Here

Ambili S Kartha
1 to 3 years

Created by Ambili S Kartha
Updated on Feb 06, 2022

In Toeing Out Toeing In Toddlers Find Out Everything Here
Reviewed by Expert panel

Mothers, especially of newborn mothers watch closely (sometimes too closely) the development of their baby and the pace of their milestone achievements. Standing and walking are considered as an important milestone by most of the mothers. That is the time they worry a lot as well.

Therefore, not expect to be it so. Kids start to stand and walk long before the muscles and bones in their feet and legs have fully developed. For that reason, you may notice some peculiarities in their gait, the way of walking during their initial steps. Do you know most of the mother may suspect their baby has bow legs once their little one starts to stand up or starts to walk!!

Believe us, your child's first steps will not be picture perfect.

Even then, it's common for kids to start walking with their toes and feet twisted at an angle, developing an abnormal gait. The most commonly found abnormal gaits among kids are in-toeing and out-toeing.

Intoeing and out-toeing are not essentially "normal," however, they are not a rare condition or a serious condition either. If you notice your child is walking in an in-toed or out-toed fashion, here is the good news… it will resolve eventually as the kid grows. However, there are some exceptions. Read on.

What is in-toeing?

Mostly, kid's or adult's feet point straight ahead when they are walking or running. Intoeing is a condition in which the feet point inward instead of pointing straight when walking or running. It is also known as "pigeon's toe"

What causes in-toeing?

The in-toeing can be caused due to three reasons. Before going to the causes you should know this:

  • These causes can run in families.
  • These causes can happen their own or can associate with other bone and muscle problems.
  • Prevention is not possible as these happen due to either genetic or developmental causes.

The three causes are:


    • Curved Foot (Metatarsus Adductus):
    • This is the most common cause of in-toeing by birth. It can either caused by positioning in the uterus or it runs in family. Here, the foot is bent inward from the middle part to the toes just like a kidney bean.If the foot is bendable and the curve is not severe, no treatment is required. However, if the foot is rigid or stiff and if your child is under 8 months, your provider may recommend casting to allow the foot to grow straight.


      • Twisted Shin (Tibial Torsion):
      • Tibial torsion happens before birth when the baby's legs rotate to fit in the restricted space in the womb. Normally, after birth, the newborn baby's legs rotate to align properly. However, if the shin has not untwisted by the time the child starts walking, his or her feet may point in. This is perceived most often two years after the baby starts to walk. As the tibia grows, most of the time, the legs will untangle.


        • Femoral Anteversion:
        • Femoral anteversion is similar to tibia torsion, except that, instead of the tibia, here, the femur (thigh bone) is twisted. Because of this, when the child walks, his or her kneecaps point inward leading to the pigeon's toe. It is often most obvious between 3-7 years of age. For some reasons, this condition happens more often in girls. It may get worse by sitting in a "W" position.

What is out-toeing?

Out-toeing also called "duck feet" can be described as an opposite condition of pigeon's toes. Besides, it is more evident than in-toeing because of the oddity of the child's walk. Out-toeing is relatively less common than in-toeing and can occur in older children as well.

Unlike in-toeing, out-toeing can bring about pain and long-term disability in children. This is for the reason that the out-toeing put massive pressure on the hip joints, legs, and feet, which obviously increases incredibly as the baby grows and put on more weight. This enhances the significance of, prompt treatment for this issue. Or else, the child has increased risk of developing childhood arthritis.

What causes out-toeing in kids?

There are common causes and less common causes of out-toeing in children.

The common causes of out-toeing includes:

  1. Hip contracture:

    During pregnancy, baby's hip can be flexed up and rotated outward to fit in the mother's womb. Because of wrongly positioned in the uterus, babies can be born with externally rotated hips. Furthermore, as the baby does not move its hip during the entire gestation period, the baby's hip can remain in this tight position after birth too. However, out-toeing due to hip contracture usually resolve on its own without any treatment
  3. External tibial torsion:

    Here, the shin bone (tibia) is twisted outward. External tibial torsion usually happens due to the positioning of the baby in the womb. External tibial torsion usually does not improve and tends to get worse as the child grows.
  4. Flat feet:

    Flat feet refers to feet with no curve or arch. Flexible flat feet are not rare among babies and toddlers. Out-toeing due to flat feet more often than not improves on its own without any treatment. Less common causes of out-toeing
  6. Femoral retroversion:

    This is a condition in which the thigh bone (femur) has a twist outward compared to the hip joint. This backward angling can cause the feet to turn outside.This is more common among obese children.
  7. Cerebral palsy(CP):

    Children with Cerebral Palsy, more often experience muscle imbalance in the legs. This can give rise to out-toeing. However, it usually appears on one leg instead of both.

How is in-toeing and out-toeing in kids treated?

There are no many treatment options for in and out-toeing in kids. More often, as earlier stated, the issue resolve on its own as the child grows. Physiotherapy or specially designed shoes may be suggested in some cases though. However, if it impaired the normal gait, or if not resolved by a certain age, surgical correction is initiated. When it comes to in-toeing and out-toeing, weight management is an important factor. Obesity will worsen both conditions.

Did you like the blog? Did you find it useful? Please share your thoughts, ideas and feedbacks with us in the comments section below as we would love to hear from you.

This content has been checked & validated by Doctors and Experts of the parentune Expert panel. Our panel consists of Neonatologist, Gynecologist, Peadiatrician, Nutritionist, Child Counselor, Education & Learning Expert, Physiotherapist, Learning disability Expert and Developmental Pead.

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| Feb 12, 2018

Thank you for this very important info mam

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