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In-toeing is word used to describe when a child walks with his or her feet or legs turned inward. There are several causes of in-toeing. Depending on the cause of the in-toeing and the age of the child, in-toeing can be normal. Below are three primary causes of in-toeing. If you believe your child in-toes or walks abnormally, he or she should be evaluated by your pediatrician or a pediatric orthopaedic specialist.

Metatarsus Adductus

Metatarsus adductus, or hook foot, is a foot deformity commonly seen in newborns, where the toes and front half of the foot are curved inward. This is often caused by the position the infant in the mother’s womb. Usually, metatarsus adductus will resolve on its own without treatment by 2 years of age. In some instances, stretching exercises may be recommended. Other treatment options include casting, braces, or in rare instances, surgery. Metatarsus adductus can be associated with other orthopaedic conditions and should be evaluated thoroughly. If you have any concerns about the position of your newborn’s feet, it would be appropriate to be seen by your pediatrician or a pediatric orthopaedic specialist.

Tibial Torsion

Tibial torsion is the rotation or twisting of the tibia or shin bone. It is the most common cause of in-toeing and is usually seen in children between ages 1 to 3. Tibial torsion is caused by the way the child was positioned in the mother’s womb and usually resolves on its own and without any treatment. Tibial torsion can be associated with other orthopaedic conditions such as hip dysplasia and metatarsus adductus. If you believe your child has tibial torsion, you should have your child evaluated by a pediatrician or a pediatric orthopaedic specialist to determine if treatment is necessary.

Femoral Anteversion

Femoral anteversion is a condition that can be described as a twisting of the top part of the femur, or thigh bone, near the hip joint. This twisting causes the entire leg to rotate or twist inward. Often these children can “W-sit” more comfortably than to sit with their legs folded in front of them in a “criss-cross-apple-sauce” position. It is more common in girls than boys and highly common in children under the age of 8. Femoral anteversion usually resolves on its own with time and without any treatment. In extreme cases of femoral anteversion that persist past age 10, surgery may be indicated. If you believe your child has femoral anteversion or any abnormal turning in of the legs, evaluation by a pediatric orthopaedic specialist is warranted.