Gait Disturbances in Children (In-Toe and Out-toe)

Gait disturbances are one of the most common concerns of parents. Children may begin walking with their feet turned in or out, leaving parents with many questions. The problem may be coming from any level between the foot and hip. Some deformities occur at one level (i.e. foot, leg, knee, or hip), while others are more complex. Some children may “grow out of it”, while others will not. Newborns and infants are born with their legs bowed and the lower leg turned in relative to the upper leg (medial tibial torsion). This represents the fetal position of the lower limbs. With the beginning of walking the lower limbs start to straighten as normal physiologic development takes place. 


Genetic: Rotational problems often run in families. When parents and siblings have grown out of it, the presenting child usually will as well.

In utero position during pregnancy may cause the foot to turn in.

Sleeping or sitting postures may not cause the problem but will delay the resolution.

Compensating mechanisms for limb deformities.

Tight muscles and ligaments at any level.

Bone deformities in the hip, femur, knee, tibia, or feet.

Examination of the Child

Observation of the child at rest, standing, walking and running.

Checking hip range of motion with the hip flexed and extended.

Checking knee structure and the rotation of the tibia on the femur (lower leg bone relative to upper bone).

Checking the position of the ankle and the leg bone to determine bone deformities.

Observation of foot posture to check for curvatures and elevation or flattening of the arch.

Neurological problems must be ruled out.


To effectively treat rotational problems, the level and severity of the deformity must be determined.

If sleeping and sitting position perpetuate the deformity, they must be changed.

There may be a need for casting the foot, ankle and leg (every two weeks) to put tight ligaments and muscles into a continuous stretch. This may be necessary for anywhere from two to eight weeks.

Physical therapy to improve muscle flexibility and to provide gait training to the child.

In shoe custom molded orthotics or gait plates to help encourage normal walking. This is especially beneficial in the flatfooted child or ones who are intoed.  Night braces or splinting to encourage and maintain correction.

In rare cases, surgery may be necessary if the problems persist and walking becomes difficult or if the child continues to fall or trip.

In most cases, continued observation of the child may be all that is necessary.

  • Dr. Robert Sheinberg is a Board-Certified Foot, Ankle and Leg Specialist practicing in Weston and Pembroke Pines since 1988. He specializes in the treatment of infants, children, teens and adults with injuries, pain and deformities. His associates, Doctors Messina, Cohen, DeSimone, Moya, Bertot, Shenassa, Jones and Goodner, care for all musculoskeletal injuries from head to toe. The South Florida Institute of Sports Medicine in Pembroke Pines is located at 17842 NW 2nd Street, 954-430-9901, in Weston at 1600 Town Center Blvd., Suite C, 954-389-5900, and in Plantation at 220 S.W. 84th Avenue, Suite 102, 954-720-1530. The practice website is