Intoeing - FAQs

Q. My 3 & 1/2 year year old son is active but I am worried about his both feet turning in while walking. Kindly advise.

Young children trip and fall a lot as their gait is immature and they are in exploratory phase of walking. Toddlers usually have a wide-based gait and put their feet down flat, causing their toe or shoe to catch the ground while on the move. Moreover, less ground clearance than in adults, taking shorter steps to go faster, tendency to overbalance as they naturally twist & turn and some degree of intoeing due to physiological torsions of long bones of lower limbs, just make things worse.

All new-borns have their weight-bearing bones like femur (thigh bone) and tibia (leg bone) twisted inwards. Parents are concerned seeing their child in-toe while weight-bearing. Majority of these children have their bones untwisting over time due to increasing age and growth in bone lengths. Hence in the normal developmental process of any child, there is an apparent bow-leggedness in the 1st two years of life, followed by knock-knees between 2 and 6 years of age, after which there is straightening of the lower limbs as in adults. The physiological ‘deformities’ mentioned are always symmetrical and within normal limits.However, if the intoeing is asymmetrical or there is knock-knees in the 1st two years or bow-leggedness after 2 years, or exaggeration of the expected deformity for that age, the child needs to be investigated to ascertain the cause. This most commonly is metabolic like vitamin-D deficiency or ‘Rickets’ which requires treatment and follow-up. Although very uncommon, a very severe persistent in-toeing which continues to affect the activities of daily living in an older child would require surgical correction.

With the above information, you may please consider getting your son assessed to make sure he has physiological lower limb torsions.

Dr Ramani Narasimhan
Senior Consultant
Pediatric Orthopaedic Surgery
Indraprastha Apollo Hospitals, New Delhi
E mail: ramanirn@hotmail.com