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Phone: 541-776-3338
Southern Oregon Foot & Ankle, LLC
Call Us 541-776-3338
Toll Free 844-899-6826

The Ins and Outs of In-toeing and Out-toeing

There’s a reason that 2-3 year olds are called “toddlers.” As their bodies are still growing and their bones are still soft, children struggle and toddle their way to mastering standing, then walking, then running.

While a certain amount of awkwardness is normal when children are learning those first few steps, you may notice their legs twisted or turned unusually far in or out. Called in-toeing and out-toeing, these are fairly normal conditions that most children do grow out of eventually without treatment. Except in severe cases, they almost never cause your child pain or impair ability to develop normal, healthy walking patterns later in life.

However, it is a good idea to keep an eye on your child’s gait, especially if a turned foot is causing significant stumbling or balance issues for your child.


By far the more common of the two broad “twisting” foot conditions, in-toeing is usually caused by one of the below conditions:

  • Metatarsus adductus. The “twist” here occurs in the middle of the foot, with the toes pointing inward. It usually does not require treatment and clears up on its own by the time your little one is around 6 months old. If the deformity is particularly rigid or severe, and still present after 9 months or so, it may be treated conservatively using casts or special shoes. Surgery is almost never required.
  • Tibial torsion. In this case, the lower leg is twisted inward, possibly as a result of cramped conditions in the womb. As your child grows and the tibia bone lengthens, it should gradually untwist on its own, generally completing the process before school age. In the worst cases, surgery to reset the bone may be considered, but usually only if the child is at least 8 years old.
  • Femoral anteversion. Here, the twist occurs all the way up at the thigh bone, meaning the feet and the knees both point inward. It may not be obvious until your child is 5 or 6. Most cases do get better on their own, but surgery may be considered in severe cases for children older than 9.


Although less common than in-toeing, the tibia (external tibial torsion) or femur (femoral retroversion) may be rotated outward rather than inward, causing out-toeing instead. As with its more common cousin, out-toeing usually corrects itself in time without treatment, in most cases by the time your child is in second grade.

When Action is Necessary

Although the vast majority of cases do not need treatment, you should still be watching your children very closely to ensure they are continuing to develop a steady, normal gait. Because improvement in the rotation of your little one’s legs may occur too gradually for you to “eyeball,” you may find it helpful to take a video of your child walking and compare footage over the course of several months. We can show you what signs to note.

If walking does not improve, you notice a lot of stumbling or pain, or you have any other concerns about the way your child moves or looks while walking, give Southern Oregon Foot & Ankle a call. Evan Merrill, DPM will carefully examine your child for any signs of other complicating neuromuscular or skeletal problems, identify the cause and severity of the deformity, determine whether any treatment is necessary, and instruct you on what to look for as your child continues to grow. Give us a call today at (541) 776-3338 to set an appointment at our Medford, OR office.