In-Toeing and Out-Toeing: A Parent's Guide to Your Little Ones’ Walking Pattern.

By Kaitlin, Physiotherapist, Maylands Healthcare Hub

"Should I be worried about my child’s feet turning in?" is one of the most common questions I hear from parents once their little one starts pulling up, cruising, and taking those first wobbly steps. It's an easy thing to fixate on as you watch every step so closely at that age. The good news is that in the vast majority of cases, in-toeing and out-toeing are completely normal parts of how a young child's legs develop over time.

What is In-Toeing and Out-Toeing?

In-toeing or you may have heard your parents say “pigeon toe”, is when a child's feet point inward while standing or walking. Out-toeing is the opposite and is when the feet point outwards, sometimes described as a "duck-footed" walk. Both come down to the natural rotation, or scientifically, the torsion of the bones in the legs and feet as they grow, and where along the leg that rotation is happening changes as your child gets older.

What is Happening at Each Age?

This is the part I find most parents appreciate understanding, because the cause usually points to how likely it is to resolve on its own:

• Under 1 year: Metatarsus adductus is the most common cause of this. This is where the front part of the foot curves inward, usually from the baby's position in the womb.

• 1–3 years: An inward twist of the shin bone (internal tibial torsion) is the most common cause once toddlers are walking. It typically improves gradually as the shin bone rotates outward with growth.

• 4 years and up: An inward twist higher up in the thigh bone (femoral anteversion) becomes the most common cause of in-toeing. It's often more noticeable around age 3–6, tends to affect both legs, and is seen twice as commonly in girls than in boys (Kahf et al., 2019).

• Out-toeing: Usually related to the shin bone rotating outwards (external tibial torsion), the thigh bone rotating outwards (femoral retroversion), or flat feet (pes planus) and is generally assessed and managed the same way as in-toeing.

Is It Normal?

For most children, yes. These rotational patterns are part of typical childhood growth and development, and the majority resolve by themselves as they grow. Most children's leg and foot alignment looks broadly "adult-like" by age 8-10. Surgery is rarely needed and is really only considered in severe cases that persist well beyond that age and are causing limitations in your child’s day to day life.

If your child is happily running, jumping, climbing, and playing without pain or difficulty, there’s usually no need to worry. In most cases, the best approach is to simply keep an eye on things and let them continue being active, rather than seeking further opinion straight away.

When It's Worth Getting Checked

That said, there are situations where I'd want to see a child in clinic rather than just monitoring from home:

• The in-toeing or out-toeing seems to be affecting balance, coordination, or gross motor skills.

• Your child trips or falls more often than seems typical for their age or compared to peers.

• There's noticeable asymmetry, which means one leg or foot turns significantly more than the other.

• Your child reports leg pain or fatigues quickly during activities.

• They're struggling with single-leg tasks like hopping, climbing stairs, or balancing.

• The pattern isn't improving, or seems to be getting more pronounced, as they get older.

None of these automatically mean something is seriously wrong, but they're a good reason to get a proper assessment rather than guessing.

What a Physio Assessment Involves

When I see a child for in-toeing or out-toeing, I'm looking at the whole picture: 

• How they walk and run 

• Where along the leg the rotation is coming from (foot, shin, or thigh)

• Their hip and knee range of motion

• Muscle strength and flexibility

• Their overall gross motor development

This helps identify the underlying cause and whether it's likely to be a "watch and wait" situation or one that would benefit from active input.

How Physio Can Help

For children who do need support, physio input might include targeted stretching and strengthening exercises, footwear advice, guidance on positioning and play habits that can influence leg rotation (like W-sitting), and ongoing monitoring through the growth years to track progress. If an assessment suggests something more structural is going on, we'll also guide you on when a referral to a paediatric orthopaedic specialist is needed.

The Reassuring Bottom Line

Most in-toeing and out-toeing is simply a normal, temporary stage of your child's development, and it corrects itself with time and growth. But if something feels off to you as a parent, trust that instinct. A quick assessment can give you clarity, a plan if one's needed, and peace of mind either way.

Not sure whether your child's walk is something to watch or something to check? Book a paediatric physiotherapy assessment with Kaitlin at Maylands Healthcare Hub for a proper look and some peace of mind.

References:

Kahf, H., Kesbeh, Y., van Baarsel, E., Patel, V., & Alonzo, N. (2019). Approach to pediatric rotational limb deformities. Orthopedic reviews, 11(3), 8118. https://doi.org/10.4081/or.2019.8118