What is in-toeing gait?
In-toeing gait refers to the walking pattern in which the feet turn inward. This is a common condition in children aged between 1 and 6–7 years. It is also known as “pigeon toe” due to the characteristic inward rotation of the feet.
At birth, it is normal for infants to have inwardly rotated feet, resulting from their intrauterine positioning. This minor deformity typically resolves on its own.
If a child begins walking and the gait does not correct, the condition is classified as in-toeing gait.
What are the symptoms of in-toeing gait?
In most cases, in-toeing is asymptomatic. However, if pain, asymmetrical hip rotation, or progressive deformity is observed, further evaluation with specialized diagnostic tests is required.
What are the causes of in-toeing gait?
Clinical examination is essential, as the orthopedic specialist assesses femoral and tibial torsion and evaluates for metatarsus adductus (inward deviation of the forefoot).
There are three main causes of in-toeing gait:
Metatarsus Adductus (Forefoot Adduction)
This deformity becomes noticeable after the age of two. The forefoot deviates inward.
If the foot is flexible, treatment may not be necessary. However, in cases of rigid deformity, corrective casting may be required. Surgical intervention is rare but may be indicated in severe cases.
Internal Tibial Torsion
This rotational deformity of the tibia is observed in children up to the age of 3. Parents may notice the condition when their child frequently trips or catches their feet while walking.
Internal tibial torsion can occur before birth, as the legs adjust to the limited space in the uterus. It typically resolves spontaneously before the child reaches school age.
Femoral Anteversion (Increased Femoral Internal Rotation):
This is the most common cause of in-toeing in children aged 5–6 years. It usually resolves on its own as the child grows.
Surgical correction (femoral derotation osteotomy) is considered only in children over 9 years of age who present with functional limitations or aesthetic concerns.
What is the treatment for in-toeing gait?
In most cases, no treatment is necessary, as spontaneous correction occurs with growth. Surgical intervention (derotation osteotomy) is required in less than 1% of torsional deformities that persist into adolescence without improvement.
How can in-toeing gait be prevented?
Internal tibial torsion and femoral anteversion are associated with the child’s sitting posture, particularly the W-sitting position, where the legs are folded backward under the body.
Management includes encouraging alternative sitting positions, such as cross-legged sitting.
Regarding the feet, if metatarsus adductus is observed during gait, the child may need to wear special orthopedic shoes that gradually correct the forefoot alignment, thereby improving toe position.
In rare cases, and usually at an older age, surgical correction may be necessary.