In-toeing
Assess the child once walking is well established, eg walking independently for 6 months.
Intoeing may be due to metatarsus adductus, internal tibial torsion or femoral anteversion.
Internal tibial torsion is a normal variant up to 7 years of age and may be symmetrical or asymmetrical. Femoral anteversion is a normal variant up to 10 years of age4 and is generally symmetrical.
Physiotherapy is not indicated for asymptomatic normal variants and cannot prevent the tripping often associated with intoeing. However there is often parental concern therefore a leaflet titled “Intoeing Gait” is available here.
Referrals for intoeing for children under 5 years of age will only be accepted if they have metatarsus adductus and/or pain.
Please see table below to assess metatarsus adductus:
If as a health practitioner you remain concerned please contact the Paediatric Orthopaedic Physiotherapy Team to discuss if referral is appropriate first either by email rch-tr.paedsorthophysio@nhs.net or phone 01872253882 for advice. The email is checked daily.
Reference:Staheli L (1983) ‘Intoeing and Outtoeing in Children’, The Journal of Family Practice, Vol 16, no 5, pp 1005-1011
Author:Dr S Burns, Dr R Hopkins
Contributors:Sarah Harvey, Paediatric Orthopaedic Physiotherapy Team Lead RCHT. Russel Hawkins, Consultant Orthopaedic Surgeon RCHT.
Date:9/6/23
Next Review Date:9/6/24
Version: 1.2