Intoeing can be caused by:
1) Internal femoral torsion: an inward twist of the leg bone.
2) Femoral antetorsion or internal femoral torsion: an inward twist of the thigh bone.
3) Femoral anteversion: an inward rotation of the thigh bone (positional) which may originate at the hip joint.
4) Metatarsus adductus: inward bowing of the foot, a “C-shaped” foot.
Metatarsus adductus (see image on top right) can be treated effectively by the following techniques:
1) Manipulation: most effective from birth through about 10 months of age.
2) Serial casting: the pediatric podiatrist places a series of casts, each one with foot held straighter than the prior cast until the deformity is resolved. Effective from about 6 weeks of age through about 14 months.
3) Wheaton brace:
this commercial brace can be used to treat metatarsus adductus and internal tibial torsion. It is effective from about 6 months of age through age 2.
Surgical treatment may be required for severe cases or if correction is not achieved by the non-surgical treatments listed. The conservative treatments are generally effective if utilized early when the joint of the foot are developing and “malleable.”
Internal tibial torsion can be treated effectively by the following techniues:
1) Serial casting
2) Dennis Browne splint: this is the old fashion bar affixed between shoes that infants sleep with at night.
3) Wheaton brace
Why should intoeing always be treated?
A toddler, learning to walk, will always widen their stance and gait to gain stability so intoeing is never normal nor can it be outgrown. If left untreated as a toddler, it will appear to improve by age 4 because there is sufficient neuromuscular development to allow a child to hold their feet straighter. There is a difference between the act of holding feet straight ahead intentionally and the actual angle of gait. The angle of gait refers to the natural position of a persons foot in gait and is determined by the shape of the foot, leg, knee, thigh and hip.
Often, a child with untreated intoeing who appears to improve, will show increased intoeing with fatigue or increased activity. Some used to call such children as clumsy or going through the “clumsy stage.” Often children appear to trip and fall easier. There is no science behind that. Such a stage does not exist.