Health 
Find a In-Toeing: Types, Symptoms, and Treatment
April 10, 2025
In-toeing is when your child’s foot points inward instead of straight ahead when he or she runs or walks. For most toddlers, in-toeing is painless and can be normal. In-toeing can come from the toes turning in, or a rotation in the shin bone or the thigh bone. In-toeing usually improves as children grow. Most children with in-toeing learn to walk, run, and play sports just like children whose feet point straight ahead.
Types of In-Toeing
In-toeing usually happens because the bones in the leg turn inward. This is normal in most toddlers. The three parts of the leg that can be rotated inward are the thighbone (femur), the shin bone (tibia), and the foot. This may run in families.
Twisted Thighbone (Femoral Anteversion): This is when the thighbone (femur) has a twist and turns inward. The hip can rotate inward more than usual. Many kids with femoral anteversion can sit in a “W” position. In almost all children, the femur bone will gradually correct and untwist by itself. This tends to happen during elementary school and takes place over many years. There are no braces, shoes, exercises, or chiropractic manipulations that will make this happen faster.
Twisted Shin Bone (Tibial Torsion) – This is when the shin bone (tibia) has a twist and turns inward. Many times, this is because the leg is rotated inward for the baby’s legs to fit in the mother’s womb during pregnancy. In almost all children, the tibia bone will gradually correct and untwist by itself, but this also can take years.
Curved Foot (Metatarsus Adductus) – This is when the foot is curved inward. This can look a little bit like a mild clubfoot deformity, but metatarsus adductus is very different from clubfoot.
Again, this usually corrects on its own after birth, but if the foot does not improve during the first year of life, braces or casts may be recommended.
Symptoms of In-Toeing
Most children with in-toeing have no pain or functional problems. Frequently, families notice that the child stands, walks, or runs with the feet pointed inward. Sometimes it will be noted that children who are into it are clumsy and trip frequently.
Examination
Your doctor will take a thorough history, especially regarding birth history and developmental milestones. Any history of pain or limping should be discussed. The physical exam will include watching your child walk and run, and checking the range of motion of the hips, knees, ankles, and feet.
The doctor will also conduct a neurological examination to assess muscle tightness, nerve and muscle function, and coordination. They will also note whether your child has femoral anteversion, tibial torsion, or metatarsus adductus.
Other Studies
The vast majority of children with in-toeing only need to be evaluated with a full history and physical exam. If there is a developmental delay, limp, pain, asymmetry, or a worsening gait, other tests like X-rays may be needed.
Treatment
Normal in-toeing in a toddler requires no treatment other than observation. It can take many years for the bones to untwist as the child grows. Special shoes, braces, or chiropractic manipulation do not make the intoeing improve any faster.
If the femoral anteversion or tibial torsion remains during middle school and causes problems with tripping or walking, surgery may be considered to cut and rotate the bone. This is very rarely needed in otherwise normal children who have femoral anteversion/ tibial torsion.
In-toeing due to femoral anteversion, tibial torsion, or metatarsus adductus tends to improve as children grow. There is a small subset of patients where the in-toeing does not resolve; however, most of these patients have no pain or functional problems.
Frequently Asked Questions
1. Will my child’s walking improve?
For most children, the twist in the leg bones gradually untwists as they grow. Their muscle control and balance also improve with age. Normal in-toeing and out-toeing usually get better with time, but it can take a while to notice progress, like watching grass grow! It might help to record a video of your child walking once a year to track the gradual improvement.
2. My parents think our pediatrician should have used braces to correct my child’s in-toeing/out-toeing, but the doctor said it wasn’t necessary. Who’s right?
In the past, doctors used special shoes, braces, and cables to correct in-toeing/out-toeing. However, studies now show that it improves on its own, and these interventions didn’t speed up the process.
3. When should I take my child to a doctor for in-toeing / out-toeing?
Your child should see a doctor if in-toeing/out-toeing doesn’t improve by kindergarten, if there’s pain, limping, developmental delays, or worsening walking. Out-toeing in one foot in teenagers is concerning, especially if there’s hip, thigh, or knee pain. In such cases, your child should be evaluated with X-rays right away.
4. My toddler trips frequently due to in-toeing. When should I be worried?
Many toddlers who have in-toeing also trip. Remember, toddlers are still learning to walk and lack the muscle control, balance, and coordination for their busy lives. In-toeing can make tripping seem worse, but as your child becomes stronger and more coordinated, the tripping will improve.
