Toeing In and Toeing Out

Toeing out (also called slew foot or duck walk) is rarer. A slight outward turn of the feet (at an angle of about ten degrees) is common in children and adults while walking. However, toeing out at an angle exceeding 30 degrees is considered abnormal.

WHAT CAUSES TOEING IN AND TOEING OUT?
The most common cause of congenital toeing in is metatarsus adductus, an inward bending of the front part of the feet resulting from the fetus' position in the womb. In this condition, the baby's feet are flexible and can be gently pushed to the normal position.

Toeing in that appears after the child begins to walk may be caused by a twisting of the shin bone, which can occur if the child regularly sleeps or sits with knees flexed and feet turned inward. Abnormal twisting also can occur in the hip joint, rotating the entire leg inward, and the feet whip out to the sides when running.

Conversely, congenital toeing out occurs if the shin bone or the hip bone is twisted outward as a result of an abnormal position in the womb.

IS MEDICAL ATTENTION NECESSARY?
In most cases, no treatment is required. Many babies toe in or out when learning to stand and walk. For example, toeing in may result when the child shifts his body weight to the middle of the foot to compensate for knock knees, which usually develop during the third year of life and disappear by age seven. Some parents fear that toeing in and toeing out will permanently harm a child's feet and ankles, but these fear are largely unfounded.

WHAT TREATMENTS ARE AVAILABLE?
A temporary deformity caused by an abnormal position in the womb can often be corrected by stretching the baby's feet gently several times a day (for example, when changing diapers); the pediatrician will teach you how. If this doesn't work, a temporary cast or night splint that holds the feet in a normal position may be necessary. Some doctors recommend reversing the baby's shoes for a while—placing the left shoe on the right foot and vice versa—to correct toeing in.

A twisted shin bone often corrects itself, but corrective splints may be necessary if the deformity is great and persists after the child has started walking. Hip abnomalities that cause toeing in and out usually require no treatment, except to avoid sleeping and sitting positions that might worsen them.

Surgery is rarely required unless metatarsus adductus goes undetected until the child reaches age two, at which time an operation may be needed to release the tissues holding the feet in the deformed position.

PREVENTING TOEING IN AND TOEING OUT
Discourage the child from assuming positions that may cause or exacerbate toeing in and toeing out. Avoid these positions:

• Sleeping on the stomach with the knees tucked up under the chest and the bottom resting on inward-turned feet

• Sleeping on the stomach or on the back with legs in a "frog-leg" position—knees wide apart, heels together and feet turned outward

• Sitting on the floor with the knees bent and the lower legs pushed out to either side (the "W" position)

• Sitting with one or both feet tucked under and turned in at the ankle

GETTING HELP
Call your doctor if:

• Your baby's feet are bent inward or outward in a fixed manner and cannot be brought to a normal position

• Toeing in or toeing out affects only one foot

• Inward- or outward-turned feet cause tripping while walking

• The feet point out at an angle that exceeds 30 degrees

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.