My child walks with his/her feet turned inwards. Could this cause problems for him/her?
“Adduction walking”
What is adduction walking?
Inward toe-in gait, also called intraversionor adducted gait, is one of the most common rotational gait problems of the lower limb in infancy and is considered a variation of normal development and resolves spontaneously in most cases (90-95%) as the child grows. . Children with this anomaly walk with their toes turned inwards, i.e. with a reduced or non-existent gait angle, and tend to trip over themselves very easily (1,2,3). (1,2,3) (1,2,3)
According to statistics, this pathology is more common in girls between 2 and 5 years of age and occurs bilaterally. (2)
The adduction gait pattern is characterised by the presence of an internal rotation of the foot axis with respect to the line of gait progression(4), this alteration can occur due to three main circumstances and it is important to know at what level the affectation is. (5,6): (5,6):
- The presence of metatarsus adductus: Metatarsus adductus, also called metatarsus varus, is a common foot deformity that manifests from birth. It causes the front part of the foot, or forefoot, to turn inward.
- Enlarged femoral anteversion: Femoral anteversion is a condition where the femoral neck tilts forward, causing the lower leg to turn inward.It is present in 10% of children and usually corrects itself over time.
- Internal tibial torsion: is the inward rotationof the tibia, in most cases bilaterally. It is the most common causeof the onset of adducted gait.
Studies show that the treatment of choice is conservative, with early examinationand detectionby a qualified specialist, together with the prescription of plantar orthoses and specific exercises, the prognosis for improvement is quite good. (7)
Bibliography
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Altinel L, Köse KC, Aksoy Y, Işik C, Erğan V, Ozdemir A. Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases. Acta Orthop Traumatol Turc [Internet]. 2007;41(3):190–4.
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Kamegaya, M., & Shinohara, Y. Gait disorders and leg deformities in children. J Orthop Sci. 2002;7(1):154-9
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Harris E. The intoeing child: etiology, prognosis, and current treatment options. Clin Podiatr Med Surg. 2013; 30: 531-565.
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Staheli LT. Rotational problems in children. Instr Course Lect. 1994;43:199-209. PMID: 9097150
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Baar A. rotational problems of lower limbs in children and adolescents. Cirugía Ortopédica Pediátrica. 2021. 32(3). 286-294
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Nourai MH, Fadaei B, Rizi AM. In-toeing and out-toeing gait conservative treatment; hip anteversion and retroversion: 10-year follow-up. J Res Med Sci. 2015 Nov;20(11):1084-7. doi: 10.4103/1735-1995.172833. PMID: 26941813; PMCID: PMC4755096
