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What Is In-Toeing And Out-Toeing?
Symptoms
What Causes In-Toeing And Out-Toeing?
Risk Factors
Diagnosis
Treatment
FAQS

We see in-toeing and out-toeing foot positions in both adults and children. When it comes to kids, their feet go through many changes as they grow, which often includes the in-toeing and out-toeing foot positions. Despite these being fairly normal variations in early childhood and primary school years, this foot posture does raise concerns for parents who worry about what it could mean long-term and whether their child’s ability to play sports, run and keep up with their friends is being impacted. Problems can arise if these foot positions persist into adulthood. Here’s what you need to know about in-toeing and out-toeing.

What Is In-Toeing And Out-Toeing?

Symptoms

In-toeing and out-toeing don’t really have ‘symptoms’ because they are more observations about a person’s foot posture rather than a medical condition. This is much like flat feet and high arches. The defining characteristics are the inward or outward rotation of the feet.

However, a rotated foot position may increase the risk of tripping and falling, and the muscles in the feet and legs may have to overwork and compensate for the foot position. This may lead to aches or pains during repetitive movements such as running or playing sports.

What Causes In-Toeing And Out-Toeing?

In-Toeing

Common causes of in-toeing can include:

Inwards rotation of the shin bone (tibial torsion)

If your shin bone (tibia) is twisting inwards below the knee, then the foot will also twist to face inwards, even if the position of the foot relative to the lower leg is relatively straight. When we see this in children, it’s often related to the child’s position when they were in the womb, and may only become noticeable once they start walking. Adults may have other causes for a shin bone that’s turning inwards.

Metatarsus adductus

Metatarsus adductus describes a position where the front half of the foot twists inwards on the back half of the foot, resulting in a bean or banana-shaped foot that gives the impression of in-toeing. Metatarsus adductus affects approximately 1 in 1000 births. Read more about it here. You cannot spontaneously develop metatarsus adductus as an adult.

Inwards rotation of the thigh bone (femoral anteversion) 

If your thigh bone (femur) is rotated inwards, your knee, lower leg and foot will also face inwards, creating in-toeing. One way to tell the difference between tibial torsion and femoral anteversion is the position of the knee - in femoral anteversion, the knee will tend to face inwards.

Out-Toeing

If you or your child is out-toeing, this may be due to:

The shin bone (tibia) rotating outwards

When the shin bone is rotated outwards below the knee, the foot also rotates outwards, creating out-toeing.

The thigh bone (femur) rotating outwards

When the thigh bone is twisted outward, the knee, shin, and foot are also positioned outward.

Outwards rotation of the hip

If the hip is rotated outwards, the leg and foot can also be rotated outwards. This outward hip rotation is often associated with muscle tightness and contractions and with the position in the womb. 

Flat feet 

Having flat feet creates more of an appearance of of out-toeing than actually having out-toeing itself. As the feet roll in and the toes point outwards, resulting in the feet that are appearing to be out-toeing.

Risk Factors

Both in-toeing and out-toeing are natural variations in childhood that can be experienced by any child, although a child’s position when in the womb can also influence the positioning and rotation of their feet and legs. The tendency to in-toe or out-toe may also run in families. In adulthood, sources include surgery on the hip, knee or foot to conditions or circumstances associated with muscular tightness or weakness.

Diagnosing in-toeing and out-toeing

Both in-toeing and out-toeing can be confidently diagnosed by your podiatrist following a physical exam and observing a person’s gait and foot posture. As part of the diagnosis, your podiatrist will also help identify where the in-toeing is coming from and use this information to guide your treatment plan.

Treatment

The best approach to treatment depends on a person’s age and symptoms. Young children who are in-toeing or out-toeing but do not have any pain or problems with their gait often do not require treatment, as the majority of cases will go on to resolve by the time they are in their early primary years. 

If a child’s foot position is causing them to regularly trip or hurt themselves, the foot position has persisted into adolescence or adulthood, or it is causing pain at any age, then treatment may be recommended. Your podiatrist can help you manage your in-toeing and out-toeing by:

• Performing a comprehensive assessment so you understand exactly what is happening and why
  
• Prescribing an exercise program which includes stretching and strengthening, where muscle tightness or weakness is identified as a contributing factor, such as in outwards hip rotation
  
• Prescribing a custom foot orthotic called a gait plate to encourage the foot to turn outwards and straighten when it is currently in-toeing
  
• Prescribing custom foot orthotics to support the feet where a flat foot posture or other biomechanical abnormalities are contributing to or exacerbating in-toeing or out-toeing
  
• Recommending good, supportive shoes to help protect your lower limbs, optimise their function and reduce your injury risk
  
• Referring your child appropriately if metatarsus adductus has been identified as the cause of their in-toeing, and has been missed at birth
  
• While surgery is not a common recommendation due to its invasive nature, in severe cases, your podiatrist can discuss with you what this would look like and refer you appropriately
  
• Keeping you supported and fully informed every step along the way
  

You can book with one of our podiatrists in Brisbane City or Newmarket here.

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