Why intoeing occurs in children and the right treatment for intoeing?

Have you seen children with their feet turned inwards when walking and/or running? Normally, toes should point straight ahead but instead they turn inwards and are referred to as being ‘pigeon toed’.

Intoeing in children is first noticed by their parents usually when the children begin to walk. Intoeing conditions resolve on their own in children less than 8 years of age. There is no requirement of braces, surgery, cast or surgery to initiate the correction process. But it can become a cause of worry if the child develops or is likely to develop abnormal gait. Consult Dr Ratnav Ratan – children orthopedist. Intoeing can be either genetic or developmental in nature and hence it cannot be prevented.

Signs of intoeing condition

• Uneven soles of footwear
• The feet of the child develop small lumps or bumps
• The child complains of pain/fatigue in the feet and legs
• The child falls and stumbles often while walking
• The child walking gait with feet turning inwards does not improve

When is orthopedic evaluation necessary for a child for his or her intoeing condition?

The following conditions make it necessary for an orthopedic evaluation of the child

• The child’s gait is affecting his or her mobility
• The child’s feet have become stiff and/or inflexible
• The intoeing conditions along with abnormal gait persist after the child has attained full growth
• The child is suffers from spina bifida or cerebral palsy, or other medical issues which is quite rare
• Upon the recommendation of your pediatrician

Intoeing can occur at various ages in growing children either on their own or in association with other medical conditions. The main cause of intoeing is the slight rotation of bones in the leg or curvature of the foot. These conditions being

• Metatarsus adductus – the foot turns inwards

The child’s foot bend inwards from the middle area of the foot till the toes. The extent of flexibility may differ from child to child, in some children it will be flexible and mild while in some it could stiff and rigid. Also, in case severe deformity, it is correlated with clubfoot deformity which requires immediate treatment.

Treatment of Metatarsus adductus

In most cases, Metatarsus adductus resolves on its own by the time the child is 6 months old. However, the treatment for severe conditions of Metatarsus adductus in babies up to 9 months involves casts and special shoes, surgery to straighten the feet is quite rare.

Orthopedic surgeon can suggest gentle stretching of the limbs when changing diapers. Also, If required, the baby will have to wear special cast and shoes.

• Tibial torsion – the shinbone turns inwards

Tibial Torsion

Tibial torsion is condition that occurs when the child is in the womb and the lower leg twists inward. In the womb, the legs have to rotate to fit in the limited space of the womb. Also, after birth the baby’s legs should be able to rotate slowly and align themselves properly. Tibial torsion is condition in which the lower leg is turned inwards.

The feet of the child with tibial torsion condition turn inward as the tibia above the foot turns inwards. The tibia is likely to untwist on its own as the child grows taller.

Tibial torsion condition do not require treatment, they resolve before the child reaches the schooling age. Surgery is suggested to children with a severe twist and walking issues, if they are at least 8 to 10 years old.

Femoral Anteversion

Femoral anteversion or excessive femoral torsion refers to the inward turning of the thighbone of the child. This condition is distinctly visible when the child reaches the age of 5 or 6 years.

There is twist in the upper end of the thighbone near the hip area due to which the hip turns inwards following which the knees and the feet also turn inward especially during walking. Children with femoral anteversion assume the “W” position on sitting. Their knees are bent while the feet are spread out on their rear side.

Femoral anteversion resolves spontaneously with age. Surgery is recommended when the child is 10 or more years old with severe deformity. In such cases, the child will trip frequently and have an abnormal gait. The orthopedic surgeon will cut the femur and realign it to its correct position.

Children with femoral anteversion can be encouraged to ski, skate, learn ballet dancing, gymnastics, drum majorette and sit in criss cross positon so that their feet turn forward.