Gait variations in children: toe-in walking

One aspect that is often striking in the gait of children is the direction in which they point their feet; the majority of the population walks with their feet pointing forward or slightly outward, but some walk with their feet pointing too far outward and many others walk with their feet tucked in farther than normal. This is often compounded in the case of young children by very frequent falls, due more to their motor immaturity than to the position of their feet, which increases the concern to correct it and thus avoid future problems.

All these variations in walking are known by child traumatologists as rotational gait disturbances, but more than disturbances, they are more or less exaggerated variations from normal, which generally improve spontaneously as the child grows.

Why do children stick their feet in or out when walking?

Sometimes, the shape of the feet can be the cause of the alterations, but in most cases the answer is not in the feet. The physical examination by the pediatric orthopedic surgeon is essential to rule out any underlying pathology responsible and to locate the origin of the rotational alteration.

Normally the orientation of the feet is due to the shape of the leg bones: the femur and the tibia. These bones have a rotation on their own axis that varies from one person to another depending on their genetics. If either bone is rotated more inward, the feet will point inward; and likewise outward.

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The rotation of the femur on its axis is called femoral anteversion; if the rotation has an internal value greater than the average, it is an increased femoral anteversion and the feet point inward. On the other hand, when the rotation is more external we speak of decreased femoral anteversion or femoral retroversion and the feet point outwards. With the tibia the same thing happens, it can present an internal tibial torsion or an external tibial torsion that will condition the orientation of the foot.

The growth solves the alterations of the march.

Children present a greater internal rotation of femur and tibia than they will have as adults. This is why it is more common to see children who tuck their feet in. In fact, this internal rotation of the femur makes them able to sit in a W position. As they grow, both the femur and the tibia rotate outwards, so that the feet come out. This usually occurs up to the age of 10 years and usually varies from child to child. This is a natural development that cannot be changed by any treatment.

It is therefore not recommended to seek remedies with insoles, braces or special shoes because they will not modify this natural evolution and will only cause discomfort to the child. It is very rare that when the child grows up the position of his feet is not adequate and normally it will not have negative consequences; if it is not the only solution is surgery.