In-toeing refers to rotation of the foot inwards relative to normal. Features of in-toeing are seen in many fetuses during gestation.
Locations of the inward rotation:
(1) femoral anteversion
(2) tibial torsion
(3) metatarsus adductus
In most cases the condition is relatively mild and does not need to be corrected as many will resolve over time.
Impacts:
(1) alteration in gait
(2) emotional distress related to self-image, especially during adolescence
(3) knee osteoarthritis in patients with tibial torsion and genu varum
(4) abnormal wear on shoes with femoral anteversion
Corrective shoes or splints may be indicated in some children.
Indications to refer a patient to an orthopedic surgeon:
(1) severe in-toeing with disability
(2) severe emotional distress
(3) presence of concurrent developmental dysplasia of the hip
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Specialty: Surgery, orthopedic
