Did you ever notice that your child falls over more frequently? Fall overs are common during the growth years. But, if it is more frequent it might be due to Intoeing gait. Continue to read this article to know more about intoeing gait.

What is intoeing gait?

Intoeing gait or pigeon-toed gait is a condition, in which the feet turn inward instead of pointing straight when the child walks or runs. It is the most common rotational deformity among young children. Intoeing usually affects both the feet but in some children, only one foot may be affected.

What are the symptoms of intoeing gait?

Intoeing gait is not associated with pain nor does it develop into arthritis. It appears worse when the child runs, causing them to get tired very easily. However, falling is not related to intoeing gait but is a part of the normal process of learning to walk.

What are the causes and risk factors of intoeing gait?

Intoeing gait mainly occurs due to three conditions as described below:

• Metatarsus adducts (inward turning of the foot or curved foot): It is a common deformity that occurs in many infants and is believed to be due to the curved positioning of the baby in the womb. Some cases are mild and flexible while others are severe and rigid.
  
  
• Tibial torsion (inward turning of the shinbone): It occurs usually before birth due to the limited space in the womb which can cause the lower legs to rotate and fit in the womb.
  
  
• Femoral anteversion (inward turning of the thighbone/ femur): It is the most common cause of intoeing gait usually evident among children aged between 2 to 4 years. A normal child has 40 degrees of femoral anteversion which gradually decreases as the child grows. If the angle is higher than this, it can lead to intoeing gait. Children with this condition prefer sitting in W position with knees bent and feet flared out behind.

The above conditions can develop on their own or may result from other orthopaedic problems. Additionally, having a family history of intoeing gait increases its risk in children.

How is intoeing gait diagnosed?

Intoeing gait is usually noticed at first by the parents when the child starts walking. The pediatric orthopedician (specialist in treating bone abnormalities) can determine whether the problem is coming from hips, legs or feet.

Initially, a thorough physical examination is done to check degree of rotational abnormality, shape, and direction of the sole, etc. Physical examination usually provides sufficient information to plan the treatment. However, imaging teste may be needed in patients with significant rotational deformity, and hip dislocation. Computed tomography (CT scan) is the best method to evaluate femoral anteversion and is used in case of complex hip deformity. Other imaging techniques which may be used include plain x-rays, fluoroscopy, and ultrasonography.

What are the treatment options?

Usually, treatment is not necessary only simple reassurance and observation is enough. Most of the children with intoeing gait will develop a normal gait by the age of 8 years even without the use of casts, braces, surgery or any other specific treatment.

• Use of special shoes, bracing or splinting and exercises are not beneficial in case of intoeing associated with femoral anteversion and tibial torsion. It is advisable to use proper fitting shoes as a corrective measure for intoeing gait associated with metatarsus adducts.
  
  
• As the child gets older, involving in activities such as out-toed walking or walking along a straight line which helps to strengthen the hips can be helpful.
  
  
• Out-toed activities, such as horse riding, ballet dance, swimming breaststroke, and martial arts may be helpful.
  
  
• The child should be encouraged to sit cross-legged instead of the frequent â€?W sit’ to stretch the hip if it is comfortable for them doing so.

Surgery

Surgery is indicated in the following conditions:

• Femoral anteversion if more than 45 degrees
• When the hip cannot be rotated laterally beyond the neutral
• When there is a functional disability or severe cosmetic deformity

De-rotational femoral osteotomy is the surgical correction for femoral anteversion which involves cutting the femur and rotating it until properly aligned. It is not considered in children under the age of 9 to 10 years due to the high chances of spontaneous correction before this age.

Prevention

Intoeing gait results from genetic or developmental problems. Therefore, it is not possible to prevent this condition.