In-toe walking: How serious an issue is it with kids?

Most adults walk with their toes pointing forward or slightly outward.  Some children  walk with their toes pointing in: they have an in-toe walking pattern or gait. 

Main causes of in-toe walking are as follows:

• Two thirds of children have an inwards twist to the top of their femur at the hip called femoral anteversion. Most of them outgrow by the age of 2 years while some children take longer and tend to walk with their knees and feet turned inwards. They often like to sit with their legs in the “W” position. In the vast majority of these children, this twist in the bone gradually disappears by the age of 7-8 years.  In a very few children, this persists long-term but is never a functional problem. However, this should not stop them from being physically active. In extremely rare cases of teenagers who have a severe twist that causes pain at the hips or knees, an operation may be considered to correct it.

• Some may have an inwards twist to their tibia called internal tibial torsion. This is very common in babies and toddlers due to “moulding” of the baby during pregnancy. It may persist for a few years but gradually disappears with the child's growth. Treatment with splints, plasters or braces does not alter it and is unnecessary. This does not cause any functional problems and children can participate in all physical activities without suffering any long-term problems.

• In some children may be due to the shape their feet which are curved and tend to hook inwards called metatarsus adductus or pigeon toes. This can also be due to “moulding” during pregnancy and is often seen in children who tend to sleep face down. More than 80% of children grow out of this by the age of 3-4 years.

If the foot is supple and flexible, treatment is not necessary. In some children with more pronounced problems and feet that are less flexible, the doctor may recommend special shoes, splints to be worn at night or, rarely, treatment with plaster casts. Very few children need an operation for their feet to be straightened. The vast majority of children do not complain of any symptoms, can participate in all physical activities and have no long-term problems.

Best way is to take care of a child's feet as much as we take care of his appearance. It's important to make sure that the clothes, socks, soft booties and bedclothes you put on your baby are loose and don't compress the feet and toes, giving them room to move around easily. In fact, it's a good idea to let your baby have some time every day with bare feet so she/he can exercise their feet and toes. Most cases of in-toe walking correct themselves as your child becomes more confident on their feet. Talk to your GP if the problem persists beyond toddlerhood or worsens, especially if it only seems to affect one foot, as there could be an underlying developmental problem that needs checking out. Never igonore.