It was a lazy Sunday morning, and I had just finished my second cup of coffee while flipping through a parenting magazine. The article I was reading featured photos of smiling toddlers and talked about early milestones, like a baby’s first steps. It brought back memories of when my nephew, Sam, had started walking—how we’d cheered him on, despite his wobbly, pigeon-toed gait.
“Every child walks their own unique path,” I thought to myself. Those little quirks, like Sam’s inward-turning feet, often worried parents, but more often than not, they were just part of growing up.
Just then, my phone buzzed with a message from my neighbor, Laura.
“Hi Dr. Priya, sorry to bother you on a Sunday. I’ve been noticing something odd with Liam’s walking—his feet seem to turn inward, and I’m a little worried. Can we talk?”
I smiled and quickly texted back. “Of course, Laura. Why don’t you stop by with Liam, and we’ll chat?”
Half an hour later, Laura showed up at my door, holding Liam’s hand. As soon as I saw his little feet turning inward with each step, I knew exactly what she was worried about.
What is Intoeing?
Image courtesy orthoinfo-hkcos.org
“Intoeing,” I began as Laura sat down with Liam on the couch, “is when a child’s feet turn inward when they walk. It’s often called ‘pigeon toes.’ Most of the time, it’s nothing to worry about and resolves on its own as the child grows.”
Laura looked relieved but still concerned. “So it’s not a deformity or something serious?”
“Not at all,” I reassured her. “It’s just the way the bones are aligned during development. It’s very common in children, and there are specific reasons why it happens depending on their age.”
What Causes Intoeing?
Laura adjusted Liam’s socks as I explained. “There are three main causes of intoeing, and they depend on the child’s stage of development.”
1. Hooked Foot (Metatarsus Varus)
“This is most common in infants,” I said. “It happens because of the baby’s position in the womb. The foot is turned inward at the ankle, and the sole looks curved, almost like a bean shape.”
Laura nodded. “I think Liam’s feet were like that when he was born.”
“That’s very common,” I said. “Most of the time, it improves on its own during the first month. If it’s still there after three months, it’s worth seeing a specialist, who might recommend a temporary plaster cast to help straighten the foot.”
2. Tibial Torsion
“This is what’s happening with Liam now,” I said, pointing to his legs. “Tibial torsion is when the shin bone, or tibia, twists inward from below the knee. It’s most noticeable when toddlers start walking.”
Laura watched Liam waddle across the room. “That’s exactly what I’ve been seeing. His feet turn inward, but he doesn’t seem bothered by it.”
“That’s a good sign,” I said. “Most cases of tibial torsion resolve on their own by the time the child reaches school age. If the twisting persists for more than 12 months or if one leg is more affected than the other, it’s a good idea to consult a specialist.”
3. Inset Hips (Femoral Torsion)
“This usually becomes noticeable in preschool or kindergarten-aged children,” I explained. “It’s caused by the thigh bone, or femur, twisting inward at the hip joint. Kids with femoral torsion often sit in a ‘W’ position, but the sitting itself isn’t the cause—it’s just how their hips naturally rotate.”
Laura frowned. “Does that mean it won’t go away?”
“Not at all,” I reassured her. “Most children outgrow femoral torsion by the age of 12. But if it persists for more than 8 years after you first notice it, or if Liam has difficulty walking, you should consult a specialist.”
When Should You Be Concerned?
Laura leaned forward. “So when should I worry? Are there any red flags I should look for?”
I listed a few signs to watch out for:
- If one leg is more twisted than the other, making the legs asymmetrical.
- If intoeing persists beyond the usual age range (e.g., tibial torsion beyond 12 months or femoral torsion beyond age 8).
- If Liam starts experiencing pain, difficulty walking, or frequent tripping.
- If the condition limits his ability to participate in physical activities.
“Liam looks like he’s doing fine now,” I added, “but it’s always good to keep an eye on his progress.”
How to Help Intoeing Improve
“Can I do anything to help?” Laura asked.
“Most of the time, intoeing resolves on its own,” I said. “But here are a few things you can do to support Liam’s natural development.”
1. Encourage Natural Movement
“Liam’s active play is actually the best thing for him,” I said. “Running, climbing, and walking help his bones align as he grows.”
2. Skip Corrective Shoes
“There’s no need for special shoes or inserts. These don’t speed up the correction process and can sometimes be uncomfortable.”
3. Monitor Sleeping Positions
“If Liam sleeps with his legs twisted under him, encourage him to sleep with his legs straight. This helps avoid unnecessary pressure on his developing bones.”
4. See a Specialist if Needed
“If intoeing persists or becomes more severe, a specialist may recommend interventions like physical therapy, exercises, or in rare cases, bracing.”
Understanding the W Position
Laura watched Liam sit on the floor and noticed his legs forming a W shape. “I’ve seen him sit like that a lot. Should I stop him?”
“The W position isn’t harmful by itself,” I said. “It’s just how some kids naturally sit when they have femoral torsion. However, encouraging other sitting positions, like cross-legged, can help improve hip rotation over time.”
Key Takeaways About Intoeing
Laura looked more relaxed as Liam climbed onto her lap. “Thanks, Dr. Priya,” she said. “I feel so much better now. I was worried it was something serious.”
“You’re doing a great job, Laura,” I said. “Liam’s intoeing is just part of his development, and it’s very likely to improve on its own.”
I summarized the main points for her:
- Intoeing is common in children and usually resolves with age.
- It’s caused by natural twists in the tibia or femur or by a hooked foot in infancy.
- Most cases don’t require treatment, and corrective shoes or inserts aren’t necessary.
- See a specialist if intoeing is asymmetrical, persists beyond the usual age, or causes pain or difficulty walking.
FAQs About Intoeing
1. What age does intoeing typically correct itself?
Most cases of tibial torsion resolve by school age, and femoral torsion improves by age 12.
2. Should I stop my child from sitting in a W position?
The W position doesn’t cause intoeing, but encouraging other sitting positions can help improve hip rotation.
3. Do special shoes or braces help with intoeing?
There’s no evidence that corrective shoes or inserts speed up the natural correction process.
4. When should I see a doctor about intoeing?
See a doctor if the legs are asymmetrical, intoeing persists beyond the expected age, or if your child has pain or difficulty walking.
As Laura and Liam headed home, I felt grateful to have eased her worries. Watching your child grow can bring endless questions, but understanding the natural quirks of development—like intoeing—can make the journey a little less stressful.