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Plymouth Paediatric Orthopaedics

In/Out Toeing

Many children walk with their feet pointing inwards or outwards rather than pointing straight forward. There is a wide physiological (normal) spectrum. Only at the very extremes of this range is any treatment required.

Treatment depends on the underlying cause. There are 3 “levels” that effect the rotation of the leg, and hence the way the foot points; the top of the thigh bone, the tibia and the foot. We assess this “rotational profile” in the clinic with your child on their tummy with their knees bent.

To change the rotation of the leg usually involves an opertion called an osteotomy. Although relatively straight forward to perform, it is not worth undertaking if your child is within the physiological normal range or has no symptoms.

Parents often report that if their child in-toes they fall over often or are clumsy. This is more often due to the child’s young age or being generally less coordinated than their class mates rather than the shape of their legs.

In-toeing is more common in young children, and improves slightly with age. They often like to sit in a “W” position.

Out-toeing is more common in older children, and is often associated with knock-knees and flat feet, none of which usually require any treatment.