Whether your baby rises from a crawl with a shaky first step or
a full-on sprint across the living room, chances are you'll be
on the edge of your seat. But remember - a child's first steps
usually aren't picture perfect.
Learning to walk takes time and practice, and it's common
for kids to start walking with their toes and feet turned at an
angle. When feet turn inward - a tendency referred to as walking
"pigeon-toed" - doctors call it
in-toeing
. When feet point outward, it's called
out-toeing
.
It can be upsetting to see your child develop an abnormal gait,
but for most toddlers with in-toeing or out-toeing, it's
usually nothing to worry about. The conditions do not cause pain
and usually improve as kids grow older.
Almost all healthy kids who toe-in or -out as toddlers learn to
run, jump, and play sports as they grow up, just the same as kids
without gait problems.
In-toeing and Out-toeing
Most toddlers toe-in or -out because of a slight rotation, or
twist, of the upper or lower leg bones.
Tibial torsion
, the most common cause of in-toeing, occurs when the lower leg
bone (tibia) tilts inward. If the tibia tilts outward, a child will
toe-out. When the thighbone, or femur, is tilted, the tibia will
also turn and give the appearance of in-toeing or out-toeing. The
medical term for this is
femoral anteversion
. In-toeing can also be caused by
metatarsus adductus
, a curvature of the foot that causes toes to point inward.
The reason some kids develop gait abnormalities and others
don't is unclear, but many experts think that a family history
of in-toeing or out-toeing plays a role. So, if you toed-in or -out
as a child, there's a chance that your child could develop the
same tendency. Additionally, a cramping of the fetus in the womb
during pregnancy could also have led to in-toeing or
out-toeing.
As a fetus grows, some of the bones have to rotate slightly to
fit into the small space of the womb. In many cases, these bones
are still rotated to some degree for the first few years of life.
Many times this is most noticeable when a child learns to walk,
because if the tibia or femur is tilted at an angle, the feet are,
too.
Does Walking Improve?
As most kids get older, their bones very gradually rotate to a
normal angle. Walking, like other skills, improves with experience,
so kids will become better able to control their muscles and
foot position.
In-toeing and out-toeing gets better over time, but the change
occurs very gradually. And, it's hard to notice. Therefore,
doctors often recommend using video clips to help parents track
improvement. Parents can record their child walking, and then wait
about a year to take another video. This usually makes it easy to
see if the gait abnormality has improved over time. In most cases,
it has. If not, parents should speak with their child's
doctor to discuss whether treatment is necessary.
In the past, special shoes and braces were used to treat gait
abnormalities. However, doctors found that these didn't make
in-toeing or out-toeing disappear any faster, so they're rarely
used anymore.
If Walking Does Not Improve
Speak with your doctor if you're concerned about
the way your child walks. For a small number of kids, gait
abnormalities can be associated with other problems. For example,
out-toeing could signal a neuromuscular condition in rare
cases.
Have your child evaluated by a doctor if you notice:
- in-toeing or out-toeing that doesn't improve by age
3
- limping or complaints of pain
- one foot that turns out more than the other
- developmental delays, such as not learning to talk as
expected
- gait abnormalities that worsen instead of improve
The doctor can then decide if more specialized exams or testing
should be done to make sure that your child gets the proper
care.
Reviewed by:
Mihir Thacker, MD
Date reviewed: October 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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