In-toe Walking

Causes and Risk Factors of In-toeing

• Metatarsus Adductus: A condition where the front part of the foot curves inward.

• Internal Tibial Torsion: A twist in the shinbone (tibia) that causes the foot to turn inward. 

• Femoral Anteversion: An inward twist of the thigh bone (internal femoral torsion) usually noticeable in children aged 4-6 years.

• Muscle and Soft Tissue Tightness: Tightness in the muscles or soft tissues especially around the hips and thighs can contribute to inward foot positioning.

• W Sitting: A sitting position where the knees are bent, and the legs form a "W" shape, which may encourage inward rotation of the legs over time. 

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Signs and Symptoms of In-toeing

• Inward-Facing Feet: Feet point inward during walking or running.

• Frequent Trips and Falls: Children may trip more often due to the inward foot position.

• Poor Balance and Coordination: Challenges with stability and coordination may be noticeable, especially during active play.

• Uneven Shoe Wear: Shoes may show more wear on the inner edges.

• Habitual W Sitting: A preference for W sitting and difficulty sitting cross-legged.

Treatment and Management of In-toeing

Mild cases of in-toeing in children may resolve naturally as the child grows. However, not all cases are classified as "mild." Early intervention is recommended, particularly when the condition is identified early and shows no noticeable improvement over time, especially after the age of 4.

Depending on the cause, treatment options include:

• Physical Therapy: Exercises to strengthen and stretch the associated muscles and improve coordination may be recommended.

• Footwear: Ensuring that children wear well-fitted, supportive shoes that allow natural movement.

• Orthotic Devices: In some cases, customized insoles or paediatric supramalleolar orthoses can support and assist with the correction of foot positioning.