toeing

Toeing is a gait and posture feature describing the orientation of the feet relative to the line of progression. The term covers toeing in (in-toeing), toeing out (out-toeing), and neutral alignment. In many people the feet rotate modestly and temporarily with growth, practice, or footwear.

In children, toeing patterns are common and often self-limiting. In-toeing in the pediatric population is usually caused by internal tibial torsion, femoral anteversion, or metatarsus adductus. Positional toeing can also occur from infant sleep posture. Out-toeing can arise from external tibial torsion, external femoral rotation, or certain foot deformities. Most cases improve as the child grows, frequently without intervention.

Persistent toeing in older children or adults may indicate structural or neuromuscular factors. Causes include musculoskeletal alignment changes, hip or knee malalignment, foot deformities, or weakness affecting gait. Toe-in or toe-out patterns can influence gait efficiency and may contribute to discomfort in the feet, ankles, knees, hips, or lower back, particularly during activity.

Diagnosis involves clinical observation of gait and foot positioning, often supplemented by measurements of limb rotation and foot alignment. Imaging, such as X-rays or, in specialized cases, CT, may be used to assess underlying bony torsion or joint pathology.

Treatment is usually conservative. Many pediatric toeing patterns require no therapy beyond monitoring. When indicated, options include physical therapy to improve flexible strength and alignment, orthotic devices or shoe modifications, and, for structural or persistent deformities causing functional impairment, surgical realignment or derotational procedures. The prognosis depends on age, underlying cause, and response to treatment.