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My son’s foot is turned inward. Does he need orthotics?

The question: My son just learned to walk and has one foot that seems to be turned inward. Do I need to be worried?

The answer: Foot positioning concerns rank among the most common questions I am asked by parents of babies and toddlers. Fortunately, most children will outgrow this problem without any special treatment.

"In-toeing" is the term that pediatricians use to describe feet that naturally turn inward (big toe toward big toe). This is sometimes referred to as "pigeon-toed." Conversely, "out-toeing" refers to feet that tend to turn outward, or what I like to call "penguin-toed."

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Your doctor will check your newborn's feet after he is born to rule out significant birth defects. In the first year of life, many babies have feet that naturally assume an in-toe or out-toe position. As a general rule, as long as the foot can be brought to a normal position with gentle pressure, there is no need for concern.

This tendency for a foot to rotate either inward or outward can persist into the second year of life when infants learn to walk. At this stage, an abnormal foot position can be quite obvious and is frequently blamed for toddlers stumbling and struggling to walk. The good news is that the act of weight-bearing and walking is actually therapeutic. Almost always in-toeing and out-toeing problems improve dramatically by age three, after 12-24 months of walking.

I have observed that bigger, heavier children tend to correct faster than their smaller, lighter peers. Prescription shoes and orthotics are not necessary, nor is there a role for physiotherapy or special insoles. After three years of age, some children will continue to have a small but noticeable amount of in-toeing or out-toeing. In my experience this almost never causes any functional impairment in the long run. These children run, jump, skate, and play sports as ably as their peers. Research has even showed that a small amount of in-toeing may actually improve an athlete's sprinting ability.

Parents should be aware that children, especially those in the late preschool years, can develop an in-toeing problem if they repeatedly sit on the floor with their legs in the "W" position. This occurs when a youngster sits on his knees with his butt on the floor and legs to either side with feet turned outward so that the legs resemble an inverted "W." Although this can be a favourite position for playing on the floor or watching television it should be discouraged.

While the vast majority of foot positioning problems are benign, there are rare instances where medical followup and treatment may be required. Warning signs that this may be the case include severe deformities of the foot that cannot be corrected with gentle pressure, persistent pain, swelling or redness of any of the limbs or joints, limping, and children who don't walk independently by 15 months of age.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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