What it means?
In-toeing means when child walks with foot pointing inwards instead of keeping the foot straight while walking. It is painless and can be normal in most of the toddlers.
What causes it?
It happens due to the leg bones turned inward. Lower limb consists of three segments – thigh bone (femur), shin bone(tibia) and the foot any of this bony segment can be rotated inward as result of that child walks with inward pointing toes
During pregnancy, in the mother’s womb the baby’s leg is rotated inwards to fit in which will gradually correct and untwist by itself over a period of time
How child will present like?
- Child with intoeing will not have pain or functional problems
- Frequently parents notice that child walks, runs or stand with the feet pointing inwards
- Most children will sit in a “W” position that means bending the knee and folding the legs backwards
- Some children with intoeing will be clumpsy and trip frequently
What are the tests required?
- Thorough details about birth history, developmental milestones, any history of pain or limping
- Child will be made to walk to assess the walking pattern, range of movements of hip, knee, ankle and foot, neurologic examination to detect intoeing is due to Femoral anteversion, tibial torsion or metatarsus adductus
- If child have developmental delay, limp or pain while walking, asymmetry or worsening of intoeing need to be evaluated further with x-rays, CT scan rotational profile
What are the treatment options?
- Toddler with intoeing will not require any form of treatment only observation enough
- As the child grows, the bone will untwist by itself and walking pattern will improve but it may take many years to happen
- No need for any special shoes or braces as it will not correct or help to improve the intoeing faster
- If the intoeing fails to correct by itself, causing problems like tripping or difficulty in walking, worsening of intoeing, asymmetric pattern needs surgery in which affected segment of bone will be cut and derotated in order to make the limb straight while walking
What will be outcome?
- As child grows, intoeing due to femoral anteversion, tibial torsion or metatarsus adductus tends to improve by itself
- In small group of children, intoeing may fail to resolve completely but most of them will not have any pain or functional problems