Causes:

The three main causes of intoeing are:

• Femoral anteversion – an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). Typically seen in ages 3-6
• Internal tibial torsion – Inward twisting of the tibia (shinbone) and is the most common cause of intoeing seen at age 1-2 years. Males and females are affected equally, and about two thirds of patients are affected bilaterally
• Metatarsus adductus – also known as metatarsus varus, is a common foot deformity noted at birth that causes the forefoot, to turn inward. Seen in the newborn up to 1 year old.

Signs and Symptoms

Signs and symptoms reported by parents/guardians include:

• Intoeing gait in early childhood
• Child classically sits in the “W” position
• Knee pain associated with tibial torsion
• Awkward running style
• When extreme in an older child, occasional functional
  limitations in sports and activities of daily living can occur
• Difficulty with tripping during walking or running activities

Treatment

Conservative Observation

• Most cases typically resolve by age 10
• Physical therapy for gait training
• Bracing, inserts and sitting restrictions do not change the natural history

Surgical Intervention

• Surgical intervention is rarely needed
• Typically performed in older children