Video Explanation: In-toeing – What Parents Need to Know

In-toeing, commonly called "walking with feet turned inward" or "pigeon-toed," is one of the most frequent concerns for parents of young children. In the vast majority of cases, it's a normal developmental variant that corrects spontaneously. **The three main causes:** 1. **Metatarsus adductus:** The foot itself curves inward. Typical of newborns, almost always resolves by age 2. More severe cases may require manipulations and casting. 2. **Internal tibial torsion:** The tibia (leg bone) is rotated inward. Common in children who recently started walking, usually corrects by age 4-5. 3. **Excessive femoral anteversion:** The femur (thigh bone) is rotated inward. Appears around ages 3-5 and may persist longer, but in most cases improves by age 10. **How to distinguish them:** Each cause has specific clinical characteristics that the orthopaedist can identify with a thorough physical examination, without need for X-rays in most cases. **Functional consequences:** In-toeing can cause frequent tripping (the foot "catches" the other one), but rarely limits sports activity. Many high-level athletes have mild residual in-toeing without consequences. **Treatment:** In almost all cases, observation and reassurance are sufficient. Braces, special shoes, and physical therapy haven't proven effective in modifying the natural course. Surgery is reserved for exceptional cases with severe deformity persisting beyond skeletal maturity.