Dr. Mark Reyneker from Family Podiatry Centre explains in-toeing and highlights the causes and treatment options.
A reasonably common condition in children, in-toeing causes the foot to point inward when walking. Intoeing is most common in infants and children under 2 years of age, and can cause clumsiness, tripping and falling plus leg and foot pain, which may be wrongly dismissed as “growing pains.”
However, in-toeing (colloquially called “pigeon toe”) can also be caused by problems with the shin bone and the thigh bone. Should there be an inward twist of the tibia bone, the shin then becomes twisted. This is commonly seen in children who are learning to walk. While the leg generally straightens out within the first year of life, some children may continue to walk pigeon-toed until the leg bone is fully grown.
During the first six years of life, the leg bones undergo a series of rotational changes, first starting by being rotated inwards. As developmental milestones such as crawling, standing and walking occur, the legs continue to derotate and by the age of 2 1/2, become reasonably straight with a mild flat arch. The rotational development of a child’s legs will stop at the age of 6.
There are several factors that cause the delay in de-rotation. The most common would be the adoption of sleeping and sitting habits. These sitting and sleeping postures prevent the leg bones from attaining their correct alignment.
A Matter of Bones
In selected cases, the kneecaps will point inward if the femoral anteversion (femur) has an inward twist at the upper thighbone. Many children display this form of in-toeing after they have begun walking. Typically, children outgrow this condition by the age of 8. The difference is in the angle of the knee – the knees pointing inwards versus the knees pointing forward while the feet are in-toeing.
While a certain degree of in-toeing is considered normal between the ages of 2 to 4, the condition may require treatment if it is more severe than expected. In-toeing can be treated using custom-made orthotics known as gait plates, which work to reverse the normal forefoot axis. Children with in-toeing should also be examined regularly by a podiatrist with sufficient experience in paediatrics, as the podiatrist can prescribe exercises to effectively tackle the condition. As such, the child should be monitored regularly for signs of improvement and to ensure no other problems occur as a result of in-toeing.