Pediatric In-Toeing and Out-Toeing

Pink Tennis ShoesHard to believe, but Michael Jordan – one of the best professional basketball players of all time – was born with an abnormality: his femur or thighbone turned inward, resulting in a condition called in-toeing. Similarly, many children are born with a bone deformity that causes feet to turn outward, a condition called out-toeing.

Causes of In-toeing and Out-toeing

"Infants are tightly packed in the womb for nine months during which the legs are contorted. They go through many changes not only after birth, but also after several years of growth," says Susan Griffith, DO, board-certified pediatric orthopedist at Bucks County Orthopedic Specialists.

Depending on the location of the misalignment of the legs or feet, in-toeing may result from one or a combination of the following:

  1. front half of foot or forefoot curves inward (metatarsus adductus of the feet), usually corrects with growth by age 1
  2. inward turn of the tibia or shinbone (internal tibia torsion), typically resolved by ages 2-3
  3. inward turn of the femur or thighbone (femoral anteversion), most often self-corrects by ages 7-9

On the other hand, out-toeing is the result of the external rotation of the thighbone, called femoral retroversion, and should not have any impact on the patient's future quality of life.

Symptoms of In-toeing and Out-toeing

Signs of internal and external rotation largely appear when a child begins to walk. Naturally an in-toer's frequent tripping or affected gait can be alarming to parents, but they need not be concerned. According to Dr. Griffith, who has seen and treated hundreds of children facing such challenges, tripping usually disappears by the age of six. And, fortunately children with in-toeing or out-toeing experience no pain; they learn to run, jump and play without any signs of long-term impact. They may even enjoy the following advantages:

  1. In-toers are often very fast runners
  2. Out-toers have a very stable gait (a major plus for wrestlers and football linemen)

Surprisingly, Jordan's femoral anteversion was never fully corrected, which may help explain his unparalleled success on the court and track, where he broke records as the highest jumper and fastest sprinter, respectively.

Treatment Options

Research shows that patients with in-toeing and out-toeing receive no benefit from braces, orthotics or surgery. Luckily, these conditions almost always resolve without treatment, most within a few years, but patients with neuromuscular issues, such as club foot or Blount's disease, may be prescribed physical therapy, bracing, surgery, casting and X-Rays.

Choose a Pediatric Orthopedist in Bucks County

If your child displays the following symptoms of in-toeing or out-toeing and/or they continue or worsen, be sure to tell your doctor:

  1. Front half of foot or forefoot turns inward
  2. Shins or thighbones turn in or outward
  3. Pain, swelling or limping
  4. Problems with gait, including tripping

Our board-certified pediatric orthopedic surgeon, Dr. Susan Griffith, has evaluated many children with in-toeing and out-toeing. As an orthopedic specialist for children, Dr. Griffith encourages parents to begin treatment for their child’s orthopedic issues early. Our mission is to properly diagnose your child’s orthopedic condition and educate you about our recommended treatment course.

Contact us today to request an appointment or call (215) 600-4714 to learn more about our pediatric orthopedic treatment options.


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