Don't Worry If Your Child Has Intoeing — They’ll Likely Grow Out of It

If your child walks or runs with their feet pointed inward, you may be wondering if it’s normal or a cause for concern. Intoeing is when a child turns one or both feet inward when they bear weight. It’s more noticeable when they’re walking or running, but it can also happen when they’re standing up. 

Intoeing is common in infants, toddlers, and school-age children. It usually goes away on its own. 

What causes intoeing?

There are three main causes of intoeing:

1. Metatarsus adductus

2. Tibial torsion

3. Femoral anteversion

Each type develops during a different time in a child’s life and for different reasons. It’s possible for children to have more than one of these conditions. 

1. Metatarsus adductus

Let’s dive into the specifics of metatarsus adductus, including its look, causes, and treatments.

What it looks like

Children with metatarsus adductus have feet that bend inward, starting at the middle part of the foot. This makes the shape of the foot look like a kidney bean. Usually both feet have metatarsus adductus, but some children have it on one side only.

You may notice that the foot bends right at the middle or only closer to the toes. This causes your child’s toes to point inward instead of straight. The effect is more obvious on the big toe. You can see this easier if your child is standing up or bearing weight. But it can be noticeable even when they’re sitting or lying down. 

Why it happens

Children are born with metatarsus adductus. It develops because of how babies were positioned in the womb before birth. If their feet were pointed inward, they’ll continue to hold their feet in that position for a while.  

When it resolves

The feet usually straighten when babies are 1 year old, though it can take up to 2 years for the feet to straighten completely. Metatarsus adductus isn’t painful, and it won’t delay a child’s development. They’ll still hit all of their developmental milestones on time, including crawling and walking. 

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Treatment

Children with metatarsus adductus usually don’t need any treatment. 

Check your child’s sleep position if they’re over 1 year old and still have metatarsus adductus. Some children sleep on their tummy with their knees drawn up to their chest and their feet bent inward. This “butt-in-the-air” position is very cute but puts extra inward pressure on the feet. Try gently turning your child onto their back or side so their feet can stretch. 

It’s rare, but some children have a very stiff foot position and may benefit from special shoes to help straighten their feet. 

2. Tibial torsion

Here’s an overview of tibial torsion, including what it looks like, why it happens, and how it’s treated. 

What it looks like

Children with tibial torsion have feet that turn inward because the end of the shinbone (tibia)  twists inward. This makes the feet point inward, but the bones in the feet are straight. The kneecap is straight, too. 

Tibial torsion usually happens on both sides, so both feet will point inward. Tibial torsion only becomes noticeable when children can stand and walk. 

Why it happens

All children are born with tibial torsion. The shinbone needs to rotate inward so babies can fit in the womb before birth. After birth, the shinbone slowly rotates outward as the bone grows. Some children have more rotation to their shinbone, which makes the tibial torsion more noticeable. 

When it resolves

Tibial torsion usually resolves by the time a child is 5 years old. Tibial torsion isn’t painful, and it doesn’t cause long-term complications like arthritis. Children can still walk, run, jump, and climb stairs normally. 

Treatment

Children with tibial torsion usually don’t need any treatment. Studies show corrective shoes/inserts and bracing won’t make their shins twist back any faster. 

In very rare cases, children may need surgery to correct tibial torsion. But this is only if they have trouble walking, trip frequently, or have a significant cosmetic problem because of tibial torsion. Surgeons will wait until a child is about 10 years old before discussing surgery. This is to give the child enough time to grow out of tibial torsion. 

3. Femoral anteversion

Let’s dive into the specifics of femoral anteversion, including its look, causes, and treatments. 

What it looks like

Femoral anteversion is caused by a twisting of the thighbone (femur). This causes a child’s hips to bend inward rather than outward. This makes both kneecaps and feet turn inward. 

Femoral anteversion becomes more noticeable when children are around 5 to 6 years old, as tibial torsion starts to go away. If you’re not sure whether your child’s intoeing is from femoral anteversion, take a look at how they sit. Children with femoral anteversion have a hard time sitting cross legged. They prefer to sit in a W shape. Contrary to popular belief, this doesn’t negatively impact hip or core development.

Why it happens

All children are born with femoral anteversion because of how they are positioned in the womb (you might be noticing the pattern). But some children have more rotation to their thighbone than others. And this can make femoral anteversion more obvious as they get older. Femoral anteversion runs in families, so this is likely due to genetics.

When it resolves

Femoral anteversion resolves as the thighbone grows. It stops being very noticeable by the time a child is 11 years old. Femoral anteversion doesn’t lead to hip dysplasia or arthritis. Children who have external tibial torsion (which is different from the internal tibial torsion reviewed above) and more pronounced femoral anteversion can develop anterior (front) knee pain. 

Treatment

Children with femoral anteversion don’t need any treatment (another pattern you’re probably noticing). Studies show shoe inserts, twister cables, and bracing won’t help. In very rare cases, children need surgery to correct femoral anteversion. But this is only if it truly affects how they walk and run. 

When is intoeing a concern?

Most intoeing is a harmless byproduct of how babies are positioned before they’re born. It goes away as children grow. The three big causes of intoeing don’t start all of a sudden. If your child has a sudden onset of intoeing, see their healthcare provider right away. It could be a sign of something more serious. 

Metatarsus adductus, tibial torsion, and femoral anteversion don’t cause: 

• Pain

• Joint or limb swelling 

• Limping

• Fever

• Inability to bear weight or walk

If your child develops one of these symptoms, see their healthcare provider right away. These are signs of more serious bone and joint conditions, like joint infections. 

Why trust our experts?

Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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