Walking with feet turned inward (in-toeing)
During their development, some children may walk with their feet turned inward, called adduction. This gait abnormality may originate from different segments of the lower limbs: the feet, shinbones (tibia), knees, thighbones (femur) or hips.
Signs and symptoms of gait abnormalities in children
Since children rarely complain of pain, parents need to be particularly attentive to the signs and symptoms:
- Walking with feet turned inward (in-toeing)
- The knees “face” each other
- The child likes to sit in a “W” position
- Frequent falls and tripping
- Fatigue after prolonged walking or physical activity
- Abnormal wearing down of shoes, especially at the tips of the toes
- Collapsing plantar arches (flat feet)
- Difficulty keeping up with other children their age during physical activities
- “C-shaped” feet
What are the causes of gait abnormalities in children
1. Excessive internal torsion of the bones in the legs (internal tibial or femoral torsion)
While parents tend to focus on signs of inward-facing feet, the problem may actually originate in the shinbone or thighbone. Whether the condition is hereditary or caused by intrauterine position during pregnancy, the bones of the legs can “twist” inward in the course of their development. Since the feet are attached to these structures, they just follow this internal rotation, leading to abnormal gait.
2. Muscle and ligament imbalance (femoral anteversion)
Tense ligaments or muscles at the hips limit the hips’ external rotation, causing the entire lower limb region to turn inward. As a result, the child walks with their knees and feet pointed inward.
3. Foot bone deformity (metatarsus adductus)
In this case, the foot’s “C” shape is what gives the appearance of inward gait. This condition is characterized by excessive inward turn of the metatarsal bones (the long bones at the base of the toes). It may be caused by muscle imbalances in the feet, genetics or, more commonly, the infant’s position inside the mother’s womb.
Progression and consequences of gait abnormalities in children
The most common way the body compensates for inward gait is flat feet. When the arches are collapsed, the front of the foot naturally pushes outward, which can artificially diminish the foot’s inward-facing appearance. This misalignment acts as a domino effect on posture and can affect the child’s musculoskeletal and postural development. Numerous problems and injuries are caused by flat feet.
Another common problem found in children with excessive internal rotation in the lower limbs is bunions (hallux valgus or HAV). This deviation of the big toe may develop gradually in childhood (juvenile bunions) or start later in adulthood.
It’s also at a young age that our brain is “programmed” to unconsciously perform certain movements, like walking, running and jumping. The more years pass, the more difficult it becomes to change these established patterns. In children who walk with their feet turned inward, the gluteal muscles, which are essential for effective propulsion in movement and for stabilizing the pelvis, are often inhibited. In adulthood, this muscle imbalance predisposes patients to numerous problems and injuries.
When excessive internal torsion of bones in the legs is not addressed at a very young age, the misalignment becomes permanent, with everlasting impacts on gait and posture. From there, further complications may arise, including arthritis, bursitis, tendinitis and periostitis (shin splints).
Gait abnormalities in children aggravating factors
- Inadequate seated and lying positions can interfere with a child’s normal development. Sitting on the feet or in a “W” position and lying on the stomach with the feet turned inward are examples of habits that maintain the excessive internal rotation in the legs.
- Some sports, such as soccer, can also cause asymmetrical development of the hip muscles and aggravate the problem.
Diagnostic of gait abnormalities
A complete biomechanical exam for children is essential to identifying the parts of the lower limbs that are forcing the feet to point inward. This exam includes an analysis of posture, gait and plantar pressure that allows us to get a comprehensive overview of the patient’s situation. Images are also taken and stored for follow-up purposes.
X-rays are also required in order to assess the alignment, length and congruence of the bones in the feet. They allow us to verify whether a “C-shaped” deformity is present (metatarsus adductus). In adolescence, X-rays help determine if the bones in the feet have stopped growing.
What can my podiatrist do about gait abnormalities in children?
1. Evaluation and follow-up
Your podiatrist has the expertise to ensure that patients’ feet develop properly. The criteria for normal development in children differ from those used for adults, and they change from year to year. Children must go through different stages of development depending on their age. Depending on the situation, your podiatrist may recommend intervention to help your child achieve proper development through exercises, splints or other treatments. Ensuring the normal development of your child’s feet is a good enough reason to pay a visit to the podiatrist. The earlier a problem is detected, the greater the potential for correcting it.
2. Exercise program
In some cases, specific muscle groups must be stimulated or stretched with exercise in order to develop adequate gait and adopt more appropriate muscular activation sequences.
3. Plantar orthotics
Orthotics are a preferred treatment option for children with gait problems. They are not “crutches”; they help align the child’s feet for optimal function and stimulate a more normal course of development. In addition, pediatric plantar orthotics help children develop appropriate muscular activation sequences.
In cases of inward gait, orthotics are specially adjusted to stimulate the outward movement of the foot and leg during propulsion. They are also fitted to prevent compensation through flat feet. Children adapt to orthotics easily and their benefit is experienced rapidly. Learn more about our pediatric orthotics for kids.
How to prevent gait abnormalities in children
It’s important to encourage your kids to adopt more appropriate seating positions (sitting cross-legged or with the legs straight out in front). It’s also recommended that kids do a variety of sporting activities so they get a chance to exercise different motor patterns.
In cases of gait abnormality, it’s important to take action at the first appearance of signs and symptoms. The longer you wait and the more the child grows, the less impact you can have on the future development of the child’s feet.
“My child walks with her feet turned inward, but I'll wait until the problem goes away with age.”
That would be a costly mistake! If there's even the slightest doubt, it's better to consult with a podiatrist. The more the child's bones, muscles, ligaments and joints develop, the harder it gets to guide their optimal growth. Orthotics may be worn from the age of three years.
And if it wasn’t gait abnormalities?
There are other problems with similar symptoms to excessive internal torsion:
- Flat feet
- High arches
- Forefoot varus
- Excessive curvature of the shins (tibia varum)
- Morton’s toe
- Cerebral palsy