Intoeing is usually seen in small children, when their toes point inwards, as opposed to straight or slightly outward. It is often referred to as pigeon toes, and may look like knock-knees. It stems from one of three skeletal rotations at different points, namely bending in of the feet themselves, twisting of the calf or twisting of the thigh. The condition is painless and usually resolves on its own as the child grows and normally requires no specific treatment or orthopedic bracing.
Many parents worry when they notice intoeing in their children and seek medical intervention. It is rarely an ongoing problem and usually resolves spontaneously over time. Diagnosis of which type of intoeing is present is done by a doctor by performing a number of measurements of the rotational angles along the legs. Intoeing does not cause any pain and usually doesn't affect the child's ability to move. Should pain be present, medical assessment should be sought for an alternative diagnosis.
Metatarsus adductus or varus is a bending in of the front of the foot, while the heel and leg are straight. It is commonly seen in infants and is thought to be caused mainly by the position of the baby while still in the uterus. It may be seen only on one foot and generally resolves on its own. Some doctors may recommend gentle stretching exercises to aid the process.
Tibial torsion, or an inward rotation of the tibia, which is the long, thick bone connecting the foot to the knee, usually becomes obvious when a child starts walking. This, too, may be caused by the positioning of the baby in utero, or may be genetically inherited. It is often seen in one leg more than the other and resolves as the legs grow.
Femoral torsion is usually diagnosed in small children, upwards of three years old. It is due to a rotation of the femur or thigh bone, which is the thick bone which joins the knees to the hips. Usually due to genetic predisposition, it is most commonly bilateral, affecting both legs equally. This rotational condition does not usually affect functioning.
Regardless of the source of intoeing, most cases are considered part of the developmental stages of normal childhood growth, require no medical intervention and will resolve on their own. Very rarely, in severe cases, or those that do not resolve spontaneously, surgery may be performed if the rotation is causing lifestyle problems or is found to be disfiguring by the patient.
