Whether your baby rises from a crawl with a shaky first step or a full-on sprint
across the living room, chances are you'll be on the edge of your seat. But remember
— a child's first steps usually aren't picture perfect.
Learning to walk takes time and practice, and it's common for kids to start walking
with their toes and feet turned at an angle. When feet turn inward — a tendency
referred to as walking "pigeon-toed" — doctors call it in-toeing.
When feet point outward, it's called out-toeing.
It can be upsetting to see your child develop an abnormal
gait, but for most toddlers with in-toeing or out-toeing, it's usually nothing
to worry about. The conditions do not cause pain and usually improve as kids grow
Almost all healthy kids who toe-in or -out as toddlers learn to run, jump, and
play sports as they grow up, just the same as kids without gait problems.
In-toeing and Out-toeing
Most toddlers toe-in or -out because of a slight rotation, or twist, of the upper
or lower leg bones.
Tibial torsion, the most common cause of in-toeing, occurs when
the lower leg bone (tibia) tilts inward. If the tibia tilts outward, a child will
toe-out. When the thighbone, or femur, is tilted, the tibia will also turn and give
the appearance of in-toeing or out-toeing. The medical term for this is femoral
anteversion. In-toeing can also be caused by metatarsus adductus,
a curvature of the foot that causes toes to point inward.
Why some kids develop gait abnormalities and others don't is unclear, but many
experts think that a family history of in-toeing or out-toeing plays a role. So, if
you toed-in or -out as a child, there's a chance that your child could develop the
Also, being cramped in the womb during pregnancy can contribute to a child in-toeing
or out-toeing. As a fetus grows, some of the bones have to rotate slightly to fit
into the small space of the uterus. In many cases, these bones are still rotated to
some degree for the first few years of life. Often this is most noticeable when a
child learns to walk because if the tibia or femur tilt at an angle, the feet will
Does Walking Improve?
As most kids get older, their bones very gradually rotate to a normal angle. Walking,
like other skills, improves with experience, so kids will become better able
to control their muscles and foot position.
In-toeing and out-toeing gets better over time, but this happens very gradually
and is hard to notice. So doctors often recommend using video clips to help parents
track improvement. Parents can record their child walking, and then wait about a year
to take another video. This usually makes it easy to see if the gait abnormality has
improved over time. In most cases, it has. If not, parents should speak with their
child's doctor to discuss whether treatment is necessary.
In the past, special shoes and braces were used to treat gait abnormalities. But
doctors found that these didn't make in-toeing or out-toeing disappear any faster,
so they're rarely used now.
If Walking Does Not Improve
Speak with your doctor if you're concerned about the way your child walks.
For a small number of kids, gait abnormalities can be associated with other problems.
For example, out-toeing could signal a neuromuscular condition in rare cases.
Have your child evaluated by a doctor if you notice:
in-toeing or out-toeing that doesn't improve by age 3
limping or complaints of pain
one foot that turns out more than the other
developmental delays, such as not learning to talk as expected
gait abnormalities that worsen instead of improve
The doctor can then decide if more specialized exams or testing should be done
to make sure that your child gets the proper care.