Does your child have an in-toe or out-toe walking pattern?

Parents can often be very concerned about the way that their young child is walking and they will often look for any sign that something is not right. There are some important clinical signs that can be seen in the way that a child walks that should be taken seriously as there may be an underlying neurological condition. At the same time, there is a lot of variability from child to child and most problems that are seen are just normal variations that almost all will grow out of them. A proper gait analysis by a health professional and an assessment of any other signs is needed to rule out the potential problems from the ones that will be naturally grown out of.

One of these is what is called an in-toe or out-toe gait pattern in which the foot points inwards or outwards when walking. These are common in children and not common in adults so a lot of them are just natural variations that are grown out of. They still do need to be taken seriously in children as a few may be a problem. The cause of the in-toeing and out-toeing can come from anywhere in the lower limb. It could be due to a soft tissue or bony problem at the hip, there could be a twist in the femur bone or the leg bones or it could be just in the alignment of the foot. It could be due to sitting too much in the W position which can lead to an in-toe walking pattern. All of these potential reasons for the in- and out- toe walking needs to be assessed as well as if the normal developmental milestones have been reached and if there is any underlying nerve problem.

The next challenge is that does it need to be treated or should it be left for the child to probably grow out of it? Parents are obviously concerned and want something done about it. There are exercises that can be done to make sure there is adequate muscle strength and range of motion of the joints that may be prescribed. The W sitting position could be avoided by children if they have a problem with in-toeing. Participating in activities like ballet could also help those who in-toe. For those that have a particularly serious problem, then there are various braces and splints that can be used to twist the lower limb in either direction, however the research evidence for the use of these is not that good. There are also devices that can be worn in the shoes called gait plates. These gait plates cause the shoe to bend across the forefoot at a different angle to force the leg into an in-toe or out-toe position depending on the angle of the gait plate. It is not known if the use of these gait plates is just cosmetic and really does or does not make a difference long term. Whatever happens, the most important treatment is education about the natural history and normal progression of these sorts of problems.