In-Toeing in Children: When to Seek Medical Advice - Rehabilitation

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Children running with an inward knee position (also known as "pigeon-toed" or "intoeing")?


Hello Dr.
Yin: I have an 8-year-old son in first grade who exhibits an inward toeing (also known as "pigeon-toed") phenomenon while running during sports, but it is not very noticeable when he walks normally.
Throughout his childhood, I have rarely seen him fall easily while walking or running.
Additionally, his arch appears to be not very pronounced, resembling a physiological flatfoot, which is similar to my own condition, although I do not have flatfoot.
However, he does complain of foot fatigue after walking on flat surfaces for a long time, but he says he does not feel fatigued after hiking a 10-kilometer round trip.
Is this a normal phenomenon? Should we consider further evaluation? Thank you for your response.

W, 40~49 year old female. Ask Date: 2016/08/19

Dr. Yin Xinbei reply Rehabilitation


It is normal for individuals with low arches to experience foot fatigue.
It is recommended to wear shoes with arch support or to place arch insoles inside the shoes to alleviate this issue.
If the heels can rest flat on the ground when squatting, it indicates that flat feet are not significantly affecting the individual, and further examination is not necessary at this time.

Reply Date: 2016/08/19

More Info


In-toeing, or "pigeon-toeing," is a common condition in children where the feet turn inward while walking or running. This phenomenon can be due to various factors, including the position of the bones in the legs and feet, muscle tone, and even the way a child walks as they grow. In many cases, in-toeing is a normal part of development and tends to resolve on its own as the child grows. However, there are specific instances when it is advisable to seek medical advice.

In your case, your 8-year-old son exhibits in-toeing primarily during running, but not while walking. This distinction is important. If he is not experiencing significant difficulties with balance or frequent falls, and if he is able to engage in physical activities such as hiking without discomfort, it may indicate that his condition is not severe. The fact that he experiences some foot fatigue after walking on flat surfaces but not during more strenuous activities like hiking could suggest that his muscles are simply adjusting to different levels of exertion.

It is also worth noting that flat feet, or "pes planus," can be a normal variant in children. Many children have flexible flat feet that do not cause pain or functional issues. If your son’s arches are not prominent but he is not experiencing pain or significant functional limitations, this may also be a normal developmental phase.

However, there are certain signs that warrant further evaluation by a pediatrician or a pediatric orthopedic specialist:
1. Pain or Discomfort: If your child experiences persistent pain in the feet, legs, or hips, especially during activities, this should be evaluated.

2. Difficulty with Activities: If he struggles with running, jumping, or other physical activities due to his foot position, it may be time to seek advice.

3. Worsening Symptoms: If the in-toeing appears to be worsening over time or if there are changes in his walking pattern, a professional assessment is recommended.

4. Family History: If there is a family history of orthopedic issues, it may be prudent to have him evaluated.

5. Age Considerations: While in-toeing is common in younger children, by age 8, if the condition is still prominent, it may be worth discussing with a healthcare provider.

In general, if your son is otherwise healthy and active, and if his in-toeing does not interfere with his daily activities, it may not require immediate intervention. However, regular monitoring is essential. Encourage him to engage in a variety of physical activities to strengthen his muscles and improve coordination.
If you decide to seek medical advice, a healthcare provider may perform a physical examination, assess his gait, and possibly recommend imaging studies if there are concerns about structural issues. Treatment options, if necessary, can range from physical therapy to orthotic devices, depending on the severity of the condition.

In conclusion, while in-toeing can be a normal developmental phase, it is essential to remain vigilant for any signs of discomfort or functional limitations. If you have any concerns, do not hesitate to consult with a pediatric specialist who can provide tailored advice based on your child's specific situation.

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