Why Does My Child Walk With Their Feet Turned In?
In-toeing, sometimes called being pigeon toed, is when a child walks with one or both feet pointing inward. It is very common in young children and is usually caused by normal variations in bone shape at the foot, shin or thigh. Most children grow out of it without any treatment. Occasionally, if it persists or causes problems, imaging can help identify the cause.
Key takeaways
- In-toeing is one of the most common reasons parents visit a children's orthopaedic clinic.
- Three main causes exist, each linked to a different part of the leg.
- The vast majority of cases resolve naturally as the child grows.
- Surgery is rarely needed and only considered when the problem persists into later childhood with functional difficulties.
- If in-toeing does not improve by age eight or causes pain, tripping or limping, further assessment is worthwhile.
What is in-toeing in children?
In-toeing is a gait pattern where the feet angle inward rather than pointing straight ahead when a child walks or runs. It is not a disease. It is a description of how the legs and feet are positioned, and it can come from the foot, the shin bone (tibia) or the thigh bone (femur).
You might notice it most when your child runs, because the inward twist becomes more obvious at speed. Many parents also spot it when they watch their child from behind.
What causes a child to walk with their feet turned in?
There are three main causes. Each one involves a normal twist in a different bone that is slightly more pronounced than average. None of them is an injury or a deformity in most cases.
A curve in the front part of the foot. Most common in babies and infants. Usually corrects by age two.
The shin bone twists inward more than usual. Typically noticed between ages one and three. Generally resolves by school age.
The thigh bone angles inward at the hip. Most obvious between ages three and six. The child may prefer W-sitting. Usually improves by age eight to ten.
Femoral anteversion is the most common cause in children over three. If it persists into adulthood, it can affect hip and knee alignment. You can read more about femoral anteversion in adults and how anteversion versus retroversion affect joint function.
How can you tell if your child is pigeon toed?
You can usually spot in-toeing by watching your child walk towards and away from you. Common signs include the following.
One or both feet angle towards each other during walking or running.
The child trips over their own feet more often than other children the same age.
Sitting on the floor with knees in front and feet out behind, forming a W shape. This is common with femoral anteversion.
When standing, the kneecaps point towards each other rather than straight ahead. This suggests the twist is at the thigh or shin.
Does in-toeing go away on its own?
Yes, in most children it does. The bones gradually untwist as the child grows, and the gait straightens without any intervention. The timing depends on the cause.
- Metatarsus adductus usually resolves by age one to two.
- Internal tibial torsion typically corrects by age four to five.
- Femoral anteversion usually improves significantly by age eight to ten.
Special shoes, insoles and braces have not been shown to speed up the process. Research consistently finds that watchful observation is the appropriate approach for the vast majority of pigeon toed children.
When should you worry about in-toeing?
Most of the time, in-toeing is nothing to worry about. However, a small number of children benefit from further assessment. Consider speaking to your GP or a paediatric specialist if any of the following apply.
- In-toeing is only on one side
- It is getting worse rather than better
- Your child is over eight and it has not improved
- It causes pain, a limp, or difficulty keeping up with other children
- There is stiffness in the hip, knee or ankle
- Both sides are affected equally
- Your child is under six
- There is no pain or limping
- Your child runs, plays and keeps up with peers
- The in-toeing is gradually improving over time
Surgery for in-toeing is rarely needed. It is only ever considered when a significant rotational problem persists well beyond the expected age of correction and causes genuine functional difficulty. Even then, it is carefully planned by a specialist after thorough assessment.
How is in-toeing assessed with standing imaging?
When a clinical examination raises questions, imaging can help measure the rotational profile of the leg bones. A standard lying-down X-ray does not show how the legs behave under the child's own body weight. Standing, weight-bearing imaging captures the true alignment as the muscles and joints work together.
At ScanAlign, low dose standing imaging uses EOS technology, which delivers about 90% less radiation than a standard X-ray, around ten times less. For children, minimising radiation is especially important, and a single standing scan can capture the full leg alignment from hip to foot.
Learn more about paediatric imaging at ScanAlign and what a scan involves.
A note on MRI. EOS shows bones, joints and alignment clearly. If your child's specialist suspects a soft-tissue, nerve or disc problem rather than a bony rotational issue, MRI is usually the better tool. The two serve different purposes and sometimes both are useful.
Not sure whether your child needs imaging? A short video call with our specialist radiographer can help you decide, at no cost and with no obligation.
Book a free video consultationFrequently asked questions about in-toeing
Yes. "Pigeon toed" is the everyday term for in-toeing. Both describe the same thing: walking with the feet pointing inward.
It depends on the cause. Foot-related in-toeing often resolves by age two. Shin-related torsion usually corrects by four or five. Thigh-bone anteversion typically improves by eight to ten. If it has not improved by then, it is worth discussing with a specialist.
Research does not support the use of special shoes, insoles or braces for typical in-toeing. These have not been shown to change the natural course of the condition. Most children simply grow out of it.
W-sitting is very common in children with femoral anteversion because it is a comfortable position for them. It is not thought to cause the anteversion, but some specialists suggest encouraging other sitting positions to promote a wider range of hip movement.
In a small number of people, femoral anteversion that does not fully correct can persist into adulthood. It may affect hip mechanics, knee tracking or overall alignment. You can read more about femoral anteversion in adults.
Most children do not need imaging. A clinical examination by a GP or paediatric specialist is usually enough. Imaging is helpful when the in-toeing is severe, one-sided, worsening, or not improving by the expected age.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. This makes it particularly suitable for children when imaging is needed.
You do not need a GP referral to book a paediatric assessment. We offer a free video consultation first so our radiographer can check whether a scan is appropriate for your child.
Pricing details are available on our FAQs page. The free video consultation will also confirm exactly what is included.
If your child has sudden leg pain with swelling, cannot bear weight at all, has numbness or weakness in the legs, or develops a fever alongside limping, seek urgent medical attention through your GP, 111 or A&E. These are not typical of in-toeing and need prompt assessment.
Concerned about your child's gait?
A free video consultation with our specialist radiographer can help you understand whether imaging would be useful, with no obligation.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Staheli LT. Rotational problems in children. Journal of Bone and Joint Surgery (American). 1993;75(6):939-949.
- NHS. In-toeing and out-toeing. NHS Inform / Great Ormond Street Hospital patient information.
- Lincoln TL, Suen PW. Common rotational variations in children. Journal of the American Academy of Orthopaedic Surgeons. 2003;11(5):312-320.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.