Toeing in/out

Common Foot and Leg Problems

When a child begins to stand and walk, their world and yours take a drastic change. As your child bears weight through his or her spine, hips, legs, and feet, many forces have to work together to accomplish this goal. As the old saying goes: “the weak link in the chain always goes first” and you may notice a lot of strange things or things that look different from other children.  The feet are one of the most noticeable areas of differences. Generally, feet will have a large range of “normal” so don’t assume that a difference means a problem. Many of the differences and seemingly abnormal positions of the feet and legs will resolve in their own and others will require bracing and/or possible surgery.

Toeing in 

Toeing in is an area to watch and check closely and this should be done by an experienced pediatric therapist. The feet may turn in from the upper leg bone, lower leg bone, or a foot problem; and this needs to be determined and monitored to assure normal development.

Feet

The toes may turn in more than the rest of the foot and this may cause your child to walk on the outside of his or her foot more than normal.  This may resolve but can worsen with time. It also may be worse in one foot.  With some interventions, this can improve; but your therapist may recommend bracing. Don’t be afraid of bracing, as it may prevent further problems.

Lower Leg

Only your therapist and doctor can fully determine if the problem is from the bone in the lower leg. The large one in the lower leg is called the Tibia and a common problem with this is called Tibial Torsion which can cause the foot to appear to toe in or out. This has a wide range of involvement and may require some surgery, but only your doctor will be able to determine this.

Upper leg

Problems that cause toeing in can originate in the upper leg bone called the femur. You may hear a term like femoral anteversion.  This is a turning of the femur that looks like the foot is turning in when your child is upright. Again the range for this is large and your doctor will guide you through a treatment plan for this.

Many other reasons for toeing in can be caused from any of these regions but these are the most common problems. Never be afraid to keep seeking an answer if all of the above are ruled out and your child continues to toe in after walking regularly for several years.  By this time, the legs should have had enough time to be upright and adjust. Remember that the “apple doesn’t fall far from the tree” meaning that your child’s foot position may be a family trait.

One more thing to note, the spine is never to be ruled out as a source of possible problems. 

Pronation (“caving in” or flatfoot)

When the arch of the foot is flat and the foot appears to rolling the arch, it is said to be pronated.  Children are mostly flat footed when they are young but the caving in of the arch will look different and may even make the front of the foot look curved out or in. This problem can be corrected with bracing/orthotics. Your therapist may recommend to not brace immediately and to monitor until your child is taking some steps. Many times, the foot will improve in its own. This problem is seen a lot with low tone children.

Supination

When the foot appears to roll outward and your child walks on the outside of their foot, the foot is said to be supinated. This problem can be corrected with bracing/orthotics. Your therapist may recommend to not brace immediately and to monitor until your child is taking some steps. Many times, the foot will improve in its own.

Toe walking

Many children walk on their toes when first standing and cruising. In fact, this is a skill that they need to be able to do as they develop but sometimes it becomes to dominate in their walking and standing posture. Remember, some toe walking is okay; but persistent toe walking can indicate a need for intervention.  One of the quick fixes for this to try is to put your child in high top shoes to help keep the heel down. It your child has high tone, this will probably not be enough. Bracing is often needed for this but not always.

Bow-leg or Knock-knee

Babies are by nature bow legged but many things change as they begin to stand and walk. If you notice that your child seems to be either bow legged or knock kneed when walking, don’t be overly worried but it is a good idea to point this out to your Doctor.  If you are being seen by a therapist, they will usually be a great source to discuss this with as well. Most of these problems resolve on their own but they need to be checked, as they might indicate other problems.

Lean to side

Any time you note that your child seems to lean to one side, this needs to be checked and the problem determined if it is from the spine or the leg. These abnormalities can worsen quickly and need to be assessed and treated.

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