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In-toeing and out-toeing

Most people’s feet point straight ahead or slightly outward.

Your child may have feet that point inward (in-toeing) or feet that point outward (out-toeing).

This is very common in childhood and usually gets better without any treatment as the child grows older.

Children with in-toeing or out-toeing are usually completely healthy.

There are things you can do to help your child correct this.

Illustration of in-toeing showing feet and knees turned inwards
In-toeing is when feet and knees are turned inwards
Illustration of out-toeing showing feet turned outwards
Out-toeing is when feet are turned outwards

Diagnosing in-toeing or out-toeing

Your GP or paediatric physiotherapist can do a complete physical examination.

This examination will:

  • measure how serious the problem is
  • check there are no other deformities or related conditions

Your GP can also tell you more about the various bone twists that can cause in-toeing. These are also known as metatarsus adductus, tibial torsion and femoral anteversion.

Who might get in-toeing or out-toeing

In-toeing and out-toeing can happen to both boys and girls. It’s much more common in infants and young children than in adolescents.

How it affects your child

Children who in-toe or out-toe might appear to trip more but this soon gets better. In-toeing will not affect your child’s ability to walk, run or jump in the long term.

In-toeing and out-toeing might appear worse when your child is tired. But the condition is not painful and they can do activities as usual.

How to help your child

You can help correct these problems in your child by:

  • choosing the right shoes
  • encouraging them to walk along a straight line (keeping feet straight)
Help with in-toeing

The following things will help your child:

  • avoid ‘W sitting’ - when a child has their knees out in front of them, but their ankles and feet are to either side of their hips
  • sit in a cross leg position - this stretches the hips in the opposite direction
  • ballet, horse riding, martial arts or swimming breaststroke
  • stretch your child's hamstring muscles if tight

As your child gets older, do activities to strengthen the hip muscles. For example, out-toed walking (penguin walking) or walking along a straight line (keeping feet straight).

Help with out-toeing

Your child should avoid:

  • wearing shoes on the opposite feet - this will not help in-toeing or out-toeing
  • heavy shoes, these may also cause your child to trip

You can help by:

  • stretching your child's hamstring muscles if tight
  • encouraging your child to do activities which strengthen the hip muscles, such as walking along a straight line (keeping feet straight)

Help your child stop walking on their tip-toes

Some children walk on their tip-toes. This usually goes away on its own if your child can stand with their feet flat.

You can help by:

  • encouraging your child to stand with their feet flat on the floor to stop them walking on their tip-toes
  • play games such as “walk like a penguin” to get your child to stand with their feet flat on the floor

When to get help for tip-toe walking

Get help from your GP or a physiotherapist if your child walks on their tip-toes and:

  • has stiff ankles
  • rarely stands with their feet flat
  • does not grow out of tip-toe walking

Page last reviewed: 5 October 2021
Next review due: 5 October 2024

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This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 8.