Angles can help forge strong buildings, create spectacular bridges, and even serve as the focal point for artistic sculptures. However, when they’re on your feet—in the form of in-toeing and out-toeing—they’re not quite as helpful.

General Overview

In-toeing occurs a lot more often than out-toeing, with 2 children affected out of every 1,000. Out-toeing is much less common. In a majority of cases, the symptoms of these conditions will go away because kids grow out of them. Even people who still have in-toeing and out-toeing issues don’t normally experience any painful symptoms or deformities from the pointing of their toes. Children who have recovered or still have the condition experience a normal lifestyle, although some may benefit from a specific treatment program of stretching, casting, and special shoes to help the problem.

Reasons for In-Toeing

This condition is diagnosed when a child’s feet point inward at a very noticeable angle, a trait that some people would call being “pigeon-toed.” Without treatment, most of these cases correct themselves between ages 6 to 8. Even when children don’t grow out of the condition, it hasn’t been shown to cause any problems besides difficulty with wearing certain shoes. It is rare to need surgery for in-toeing. Here are some of the causes:

Metatarsus Adductus

This is characterized by an inwardly curved foot developed from its position in the womb. For infants with a mild case, the foot will correct over time. In a moderate case, you can gently stretch the foot by pushing in the opposite direction. The aim of stretching is to get the foot to fit in a shoe without problems. This condition may require special shoes if it’s too bothersome.

Tibial Torsion

The inward twist of the tibia bone is common and usually corrected by the time your child is 1 year old. When the condition lasts longer, you may want to bring your child to the McDowell Orthopedics & Podiatry Group for observation. We may not prescribe a cast, as most cases go away when the child reaches 4 to 6 years old. In 10 percent of those instances, stance won’t correct. However, this has not been shown to cause any arthritis or problems with function later in life. Surgery is rare when this cause for in-toeing appears without a neuromuscular problem behind it.

Femoral Anteversion

This involves an inward twist of the upper thigh bone at the hip. All children are born with this condition. As they grow, their ligaments in the hip strengthen, which naturally corrects the twist. Most people notice this case of in-toeing when their children are between 2 and 4 years old and the hip ligaments are still loose. The majority of children will grow out of the condition by 8 years old. If necessary, the bone will be cut and rotated in an operation so that the feet lie normally.


This is seen, albeit rarely, in children when they first start walking, and is signified by the feet pointing outward. The problem usually resolves itself within a year of their first steps. This may also occur from a neuromuscular condition. If your child doesn’t grow out of this condition, and he or she is nearing the teenage years, we may discuss surgical options with you.

We appreciate that you would consider the McDowell Orthopedics & Podiatry Group to help with your children’s in-toeing, out-toeing, and other foot problems. We are truly dedicated to providing you with the most expert, up-to-date treatment to correct these conditions. Please call our office in Carmichael, CA, at (916) 961-3434 to make an appointment with Dr. Brian McDowell and Dr. Gavin P. Ripp. Find us on Facebook and Twitter too!

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