In-toeing and Out-toeing


In-toeing (internal tibial torsion)

Internal tibial torsion – when the bones in the lower leg below the knee are turned inward – is commonly called pigeon toes. In-toeing is related to the position of a child’s legs while he/she is in the womb. This is usually first noticed when the child starts walking. As your child grows, in-toeing may correct itself. This can happen up to about 6 years of age. Special shoes and bars were used in the past, but do not help. Any type of shoes can be worn as long as they fit properly.

In-toeing (femoral anteversion)

Femoral anteversion occurs when the bone in the upper leg is turned inward. It is a normal part of growth that may improve up to about 8 years of age. This is usually noticed around the age of 3. These children like to sit in the W position with their legs folded under them. There are no shoes or braces that help.

Out-toeing (femoral retroversion)

Young children often walk with their feet turned out as a way to keep their balance. Children with out-toeing should be evaluated for hip problems, but most will get better as they get older.

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Patients can be seen by Texas Children's experts in Texas Children's Pediatrics.

Causes & Risk Factors

In-toeing and out-toeing are normal variations for children and do not require correction. Neither condition will cause long-term problems.

Symptoms & Types

While in the past, special shoes and bars were used, they do not help. Any type of shoes can be worn as long as they fit properly.

Diagnosis & Tests

A physical exam by your primary care provider can help decide if a specialist is needed.

Treatment & Care

No treatment is necessary, but sports that involve foot positioning such as ballet, karate and soccer may help improve range of motion.