In-Toeing In Children & Adults – What Is Normal?

It may just be our *podiatry eyes*, but we’ve definitely seen quite a few adults walking around with one or both feet turned inwards recently. Adult in-toeing (and out-toeing, for that matter) starts at a young age, and progresses into adulthood without ever completely “correcting” itself. With this in mind, we wanted to answer a common question we get from parents -“will my child’s feet straighten – and when?”

Today we’ve answered this for you while helping you understand why in-toeing occurs, when it is (and more importantly, isn’t) normal, and when you should seek help.

Is in-toeing ever ‘normal’?

To put your mind at ease, yes it is. In-toeing can be normal during the first few years as kids learn to walk. Their bodies and lower limbs are developing, gaining strength and flexibility very quickly, in-toeing can be a normal variant in this process. In-toeing below the age of four should not be a cause for immediate concern, unless it is affecting your child in other ways like:

Causing them pain or aches
Leading to regular tripping or falling (which can lead to injury)
Affecting their balance or coordination
When can in-toeing be problematic?

Our rule is that in-toeing should be outgrown by the age of four. This means that it definitely has no ‘normal’ place in adulthood.

There are many reasons that we want straight feet after this age:

Inwards-facing feet can make you more vulnerable to tripping and falling. As kids tend to increase their activities and participation in sports as they grow, moving with greater speed, a fall could mean a more serious injury from the impact.

There’s an alignment-related reason behind the in-toeing. The shin bone (tibia) may also be inwards rotated – as may the hips. When these positions are sustained for a long time, muscles and ligaments may shorten and elongate accordingly, making it more difficult (and requiring a lot more effort) to correct this in the future.

You may have a higher risk of other problems or injuries. When your body is out of an optimal alignment, your body will be compensating to help correct any barriers or deficiencies. This may mean that your muscles have to work harder, leaving them more vulnerable to overuse injuries or other problems. As everyone can compensate differently, this needs to be assessed case-by-case.

To be perfectly clear, not everyone that continues in-toeing past the age of four will develop pains or problems. The likelihood of this happening, however, is greater than in someone with straight feet.

What causes in-toeing in the first place?

There are three primary causes of in-toeing that we see here at Optimise Health. They are:

Metatarsus adductus. You’ll know if your child has this one as it’s present from birth, with their feet in the shape of a bean. Currently, it is estimated that around 1 in 1000 births may be affected. Most cases will resolve within 2 years, and often requires some gentle, regular stretching of the foot. Sometimes, casting or other measures are required to help correct the problem.

Internal tibial torsion (rotation). This is just a fancy way of saying that the shin bone is twisting inwards, hence causing the foot to rotate inwards. You may not notice this until your child starts to walk, and it is thought to be related to the baby’s position during pregnancy.

Femoral anteversion. Again, the medical term for the inwards rotation of the femur (thigh bone). This may occur in up to 10% of kids, and you may see the kneecaps turning in towards one another. Children may be predisposed to this, or it may be influenced by the way they sit (like in the W position).

How is in-toeing treated?

The good news is that regardless of the cause, the prognosis for in-toeing is good – meaning that if it doesn’t correct itself, it is very often manageable. Treatment may include stretches, orthotics (we use a special orthotic for in-toeing called a gait plate), good footwear and serial casting. We don’t see kids needing surgery for in-toeing very often at all – though this is also a possibility.

If your child is past the age of four and you’re worried about their in-toeing or the side-effects of the in-toeing (tripping and injuring themselves), book your child in for an appointment with our podiatry team. We’ve been proudly serving Toowoomba and the Darling Downs for over 20 years, and love helping families optimise their health, so they can realise their full potential.