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In-toe and Out-toe Walking

Most toddlers have differences in their steps, but as a parent you will naturally be quite anxious watching their first years of walking. Complaints of in-toeing and out-toeing are mostly associated with paediatrics (children) and are highlighted when parents, relatives or friends notice these subtle differences in their children’s walking patterns and lower extremity development.


In-toeing and Out-toeing are common rotational and angular abnormalities of the lower extremities in children. Learning to walk is challenging and children will alter their gait to ensure balance and stability as they push themselves to get from A to B. The toes will turn in, out, push up, roll around as long as they can move.

Children may not fully understand what is happening with their legs which results in complaints of not being a good runner, not fast enough, pain in their feet, knees or back. It may even present as your child falling over often and easily or simply wanting to be carried or massaged more frequently.


In-toeing is when the big toe points towards the mid-line of the body (pigeon toe)

  • Metatarsus adductus
  • Internal tibial torsion
  • Increased femoral retroversion
  • Knock knees (genu varum)
  • Metabolic bone disease

Out-toeing is when the big toe points away from the mid-line of the body

  • Femoral anti-version
  • External tibial torsion
  • Bow legs (genu valgum)
  • Metabolic bone disease

There is no clear reason as to why some children develop abnormalities and others don’t. Researches hypothesis that it may be due to family history (genetics) and the foetal position in the womb as some bones have to rotate to fit into the small space of the womb. Therefore, if you had problems as a child, your little ones might also.


Podiatrists are specialists in assessing and interpreting the normal and abnormal range of motion in the lower limbs. Those patients with a range of motion that deviates from these normal variances are said to have a deformity. This is nothing for parents to get too worried about and the differences normally do not cause pain, with improvements as they age. It is not uncommon that a full length radiological view may be requested to define the degree of lower limb rotations.

These biomechanical variances can improve with time in healthy children as they learn to run, jump and do sports but many children do require serial measurements and conservative treatment. This includes special shoes, braces, orthotics, stretching and exercises. Surgical correction of such alignment concerns is normally reserved for older children or severe cases.



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