In-Toeing & Out-Toeing

Back of two feet and ankles with a highlighted red area over the Achilles tendinopathy showing pain

Children’s feet go through many changes as they grow, two of which include an in-toeing and out-toeing foot position. Despite being normal variations in early childhood and primary school years, this foot posture can raise concerns for parents who worry about the long-term prognosis, and whether the foot posture will interfere in their child’s ability to play sports, run and keep up with their friends. Here’s what you need to know about in-toeing and out-toeing.

What Is In-Toeing And Out-Toeing?

In-toeing and out-toeing describe the specific way that the forefoot is positioned relative to the hindfoot (the heels). In-toeing, which is often called ‘pigeon-toeing’, describes the front of the feet rotating inwards, coming closer to one another when standing. This inwards rotation may be mild or very pronounced, and may affect one or both feet. Generally speaking, the ‘normal’ period of in-toeing can range from the first steps up to four years of age.

Out-toeing is the opposite of in-toeing, where the forefoot twists outwards away from the other foot. This is described as being ‘duck-footed’ and also generally resolves by the age of four or five years old. Both positions can help a child learning to walk find their balance and improve their walking confidence, and both conditions can occasionally persist into adulthood.


In-toeing and out-toeing don’t really have ‘symptoms’ because they are more observations about a person’s foot posture than a medical condition, much like flat feet and high arches. The defining characteristics are the inwards or outwards rotation of the feet.

As a result of the variations in foot position, however, there may be a higher risk of tripping and falling, and the muscles in the feet and legs may have to overwork and compensate for the foot position, which may lead to aches or pains during repetitive movements such as running or playing sport.

What Causes In-Toeing And Out-Toeing?


Common causes of in-toeing can include:

Inwards rotation of the shin bone (tibial torsion)

If your shin bone (tibia) is twisting inwards below the knee, then the foot will also twist to face inwards, even if the position of the foot relative to the lower leg is relatively straight. When observed in children, this position is often related to the child’s position in the womb, and may only become noticeable once they start walking. 

Metatarsus adductus

Metatarsus adductus describes a position where the front half of the foot twists inwards on the back half of the foot, resulting in a bean or banana shaped foot which gives the impression of in-toeing. Metatarsus adductus affects approximately 1 in 1000 births.

Inwards rotation of the thigh bone (femoral anteversion) 

If your thigh bone (femur) is rotated inwards, then your knee, lower leg and foot will face inwards too to create in-toeing. One way to tell the difference between tibial torsion and femoral anteversion is the position of the knee - in femoral anteversion, the knee will tend to face inwards, too.


An out-toeing foot posture may be contributed to by:

The shin bone (tibia) rotating outwards

When the shin bone is rotated outwards below the knee, then the foot will also rotate outwards and create out-toeing.

The thigh bone (femur) rotating outwards

When the thigh bone is twisted outwards, this positions the knee, shin bone and foot outwards too.

Outwards rotation of the hip

If the hip is rotated outwards, then this can rotate the leg outwards, including the foot. An outwards hip rotation is often associated with muscle tightness and contractions, and is often associated with the position in the womb. 

Flat feet 

Having flat feet creates more of an appearance of out-toeing, than actually having out-toeing itself. As the feet roll in and the toes point outwards, the feet appear to be out-toeing.

Risk Factors

Both in-toeing and out-toeing are natural variations in childhood that can be experienced by any child, although a child’s position in the womb can also influence the positioning and rotation of their feet and legs, and the tendency to in-toe or out-toe may also run in families.


Both in-toeing and out-toeing can be confidently diagnosed by your podiatrist following a physical exam and observing a person’s gait and foot posture. As part of the diagnosis, your podiatrist will also help identify where the in-toeing is coming from, and use this information to guide your treatment plan.


The best approach to treatment depends on a person’s age and symptoms. In young children who display either in-toeing or out-toeing but do not have any pain or problems with their gait, treatment is usually not needed, as the majority of in-toeing and out-toeing cases will go on to resolve by the time they are in their early primary years. 

If a child’s foot position is causing them to regularly trip or hurt themselves, the foot position has persisted into adolescence or adulthood, or it is causing pain at any age, then treatment may be recommended. Your podiatrist can help you manage your in-toeing and out-toeing by:

  • Performing a comprehensive assessment so you understand exactly what is happening and why
  • Prescribing an exercise program which includes stretching and strengthening, where muscle tightness of weakness is identified as a contributing factor, such as in outwards hip rotation
  • Prescribing a custom foot orthotic called a gait plate to encourage the foot to turn outwards and straighten when it is currently in-toeing
  • Prescribing custom foot orthotics to support the feet where a flat foot posture or other biomechanical abnormalities are contributing to or exacerbating in-toeing or out-toeing
  • Recommending good, supportive shoes to help protect your lower limbs, optimise their function and reduce your injury risk
  • Referring your child appropriately if metatarsus adductus has been identified as the cause of their in-toeing, and has been missed at birth
  • While surgery is not a common recommendation due to its invasive nature, in severe cases, your podiatrist can discuss with you what this would look like and refer you appropriately
  • Keeping you supported and fully informed every step along the way

You can book in with one of our podiatrists in Brisbane City or Newmarket here.


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