Intoeing in children

Intoeing in children

Intoeing or Intoe gait is walking pattern in which the feet turn or point inward instead of pointing straight. It also called as pigeon toed gait. It is usually noticed by parents or grandparents when the child starts walking. In some cases children may have intoeing due to other reasons. In case of severe intoeing, child may trip and fall as the toes get locked with other heel.

Intoeing is usually seen in 10% of children aged between 2 to 5 years. It is usually benign condition and foot can be corrected by the age of 8 years. Intoeing gait with pain, limp, and swelling may need attention from orthopedic doctor.

Causes:

There are three most common conditions causing intoeing.

Metatarsus adductus - Curved foot.Tibial torsion – twisted shinFemoral anteversion – twisted thigh bone

Sometimes these conditions are associated with other orthopedic problems. Some of these conditions run in families as there is some genetic predisposition.

1. Metatarsus adductus: It is a condition in which half of the foot in the front is turned inwards with toes pointing to the center of body axis. Some deformities may be mild and flexible and some may be severe and rigid. In severe cases foot can resemble like a club foot. It usually corrects by the age 4 to 6 months. If the deformity is not getting corrected by the age of 9 months and foot are rigid manipulation and serial plaster cast will correct the deformity.  Surgery is seldom required.

2. Tibial torsion: This is a condition in which lower part of the child’s leg (Tibia) is twisted inwards. This usually starts in the mother’s womb in which developing fetus legs rotate to accommodate in the womb. After the birth the child’s leg gradually remodels back to normal position. As the child starts walking the foot and toes point inwards because lower end of leg bone is twisted inwards. This usually corrects by the age of 8 years. Use of splints, braces or shoes do not help. Surgery to correct the rotation of tibia is considered in severe deformities or if deformity persists or beyond 8 to 10 years.

3. Femoral anteversion : This is condition in which the childs thigh bone (Femur) is rotated inwards. This occurs at the hip joint where the thigh bone is rotated inwards. As the thigh bone is rotated inwards the knee and feet are also turned inward while walking. Children with this condition usually sits in W position. Excessive femoral anteversion gets corrected by the age of 6 years. Surgery is considered in children above 9 years,  when the deformity is severe, unstable gait, frequent fall due to tripping. Surgery involves cutting of the upper end of thigh bone and rotating it back to normal position.