In-toeing, Out-toeing, Toe Walking, Curly Toes

In-toeing, Out-toeing, Toe walking, Curly toes

Rachel Miller is a highly experienced HCPC-registered podiatrist specialising in children’s foot care, paediatric podiatry. Rachel treats many children who have the conditions in-toeing, out-toeing, toe walking or curly toes.

For most children, it is normal for them to present with in-toeing, out-toeing, toe walking or curly toes. These conditions often correct themselves.  However, if your child seems to be in pain, frequently trips, or you have concerns about their development, an assessment from an experienced podiatrist can help diagnose if there is a problem and suggest a treatment plan.

Please see below if you want more detailed explanation of these conditions.

In-toeing, Out-toeing, Toe Walking, Curly Toes

In-toeing

In-toeing, also known as pigeon toes, is when the foot turns inwards and can affect one or both feet. Your child may limp, stumble or trip during running or walking. In most cases, this condition will improve with maturity and does not require treatment.

There are 3 types of in-toeing and their exact cause is not fully understood:

• Curved foot (metatarsus adductus), which is usually present at birth.
• Twisted shin (tibia torsion), is the most common cause of in-toeing, which usually occurs around the ages of 1 to 3.
• Twisted thighbone (femoral anteversion), which occurs around the ages of 3 to 8.

If in-toeing continues, it should be evaluated by an experienced podiatrist. In-toeing can potentially lead to foot deformities such as bunions, hammertoe and flat feet. In rare cases, it may be a sign of other, more serious conditions such as neurological or genetic disorders.

The treatment approach will depend on the specific cause and type of in-toeing and may involve:

• advice about activities which may help improve the condition
• postural advice
• footwear advice
• a custom orthotic insole can be prescribed.

Out-toeing

Out-toeing refers to the condition when one or both feet point outwards. Out-toeing does not often cause pain but may result in difficulty walking and running. In most cases, out-toeing does not require treatment.

The majority of cases occur due to the rotation of either the thigh bone or the shin bone.

Occasionally, out-toeing is caused by a condition called developmental dysplasia of the hip, a dislocation of the hip joint, especially if only one foot is in an out-toed position. This condition should be evaluated by an experienced podiatrist.

Toe walking

Toe walking is common and children from around 10 months onward can walk on tip toes. This behavior may continue for some years and in most cases there are no identifiable reasons but possible underlying causes can include:

• short calf muscles
• habit, a child gets accustomed to tip toe walking
• a child enjoys the sensation of being on their toes or dislikes the sensation of their feet touching the ground
• toe walking can have an underlying cause, such as a congenital tightness of muscle
• there can be a neurological or developmental issue

Some children, if they continue with toe walking, develop stiffness, tightening and pain in their Achilles tendon. An assessment from an experienced podiatrist may help find any underlying cause for toe walking.

Treatment for toe walking can include:

• stretching exercises can help alleviate symptoms
• activities and exercises to help strengthen muscles
• footwear advice
• a custom orthotic insole

Curly toes

Curly toes are a common condition that is often present at birth. They typically affect the 3^rd, 4^th and 5^th toe of one or both feet.

The underlying cause for curly toes is the tendons, that bend the toes, are too tight. The exact reason for this tightness is not completely understood, the shape of the toe bone may be relevant and the condition could be inherited.

For the majority of children, curly toes do not cause a problem. However, some may experience some symptoms including:

• sores
• blisters
• hard skin
• pain in their feet
• choosing the right shoes can be a difficulty.

To alleviate symptoms and manage curly toes effectively, an assessment with an experienced podiatrist can be helpful. You might be provided guidance which can help address any discomfort associated with curly toes including:

• appropriate stretching exercise
• advice on choosing suitable footwear  

Rachel Miller is a highly experienced podiatrist specialising in biomechanics and orthotic insoles who sees many children with the conditions in-toeing, out-toeing, toe walking or curly toes.  Her clinic, Highgate Podiatry, is in Highgate Village, 14 Pond Square, N6 6BA, London. Clinics are held every Wednesday, Thursday, Friday and Sunday. Please contact the clinic for an appointment on 020 8348 5553. For the clinic’s address, map and directions see the Contact page and for information about orthotic insoles and biomechanics see the Biomechanics page.