Intoeing – A matter of parental concern.

Intoeing means that when a child walks or runs, the feet turn inwards instead of pointing straight ahead. It is also referred to as "pigeon-toed". Intoeing is often noticed by parents when a baby starts to walk. In addition, it is a common cause of parental apprehension.

Three conditions causes intoeing -

A. Metatarsus adductus - Foot is "C" shaped on the lateral aspect of the foot. The foot turns inwards. And about 90 percent of cases resolve by 4 to 6 months of life. Babies aged 6 to 9 months with severe rigid deformity may be treated with casts or special shoes. However, surgery is seldom required.

B. Internal tibial torsion - Tibia or shin bone turns inwards. It is a normal finding in the newborn. However, it will resolve by walking age. Persistent internal tibial torsion after 3 years of age is a matter of concern. It needs further evaluation and intervention. Splints, special shoes, and exercise programs do not help.

C. Excessive femoral anteversion - It is the most common cause of intoeing. Here the thigh bone turns inwards. The child stands or walks with both patellae and feet pointing inwards. It is most obvious at about 5 or 6 years of age. children with this condition often sit in the "W" position.

Above all, the disability due to intoeing is extremely rare. Most femoral anteversion spontaneously corrects in almost all children as they grow. Special shoes, braces, and exercises do not help. However, while waiting for spontaneous recovery, avoid “W” sitting and encourage activities like cycling and swimming. Surgery is usually considered in children older than 8 years. The indication for surgery is frequent tripping and an unsightly gait. The surgery includes corrective derotation osteotomy of the femur.

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