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Health condition

In-toeing and out-toeing

Feet that point inwards or outwards when a child walks are among the commonest reasons for orthopaedic referral - and among the most benign: nearly all cases straighten with growth, without braces, insoles or surgery.

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against current NHS and UK specialist society guidance at the time of review.

  • 03

    Current for 2026

    Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.

Key facts

The essentials at a glance.

The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.

  • The three usual causes of in-toeing: curved feet in babies (metatarsus adductus), twisted shin bones in toddlers (tibial torsion), and inward-pointing thigh bones in young children (femoral anteversion)

  • Each has its own timetable and virtually all resolve naturally - femoral anteversion, the W-sitting pattern, corrects by around age 8-10

  • Braces, special shoes and insoles do not change the outcome and are no longer recommended

  • Specialist review is warranted when the pattern is one-sided, painful, stiff, progressive, or accompanied by tripping that worsens rather than improves

Understanding the condition

What it is and what happens next.

What causes it, how it is diagnosed, and the treatment routes available in the UK.

What it is and how it feels

A child who walks with pigeon toes, sits in a W and wears down shoes unevenly worries parents and grandparents alike, but rotational variations are part of normal skeletal development: the shin and thigh bones start life with a twist that gradually unwinds through the growing years. Each cause has a characteristic age - curved feet in infancy, shin-bone rotation in toddlers, thigh-bone rotation in the early school years - and each has an excellent record of correcting itself as the child grows.

Diagnosis and treatment routes

Assessment is largely reassurance done properly: watching the child walk and run, measuring the rotational profile of hips, shins and feet, and confirming the pattern is symmetrical, painless and age-appropriate; X-rays are rarely needed. The consultation matters most for identifying the exceptions - asymmetry, pain, stiffness, neurological signs or deterioration - which deserve investigation, and for the small minority whose severe rotation persists towards the end of growth, where corrective surgery exists but is very seldom required. In many parts of the UK, routine NHS referrals for this kind of problem currently take 20-45+ weeks, whereas an initial appointment with a private consultant is typically available within around two weeks.

Seeing a specialist

Who to see, and how quickly you can be seen.

The specialist for this condition is usually a consultant paediatric orthopaedic surgeon. Your GP can refer you on the NHS, or you can arrange a private consultation directly.

A quiet reminder

This guide is for information, not medical advice.

Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.

Frequently asked

Common questions about In-toeing and out-toeing.

Quick, plain-English answers to what people ask us most.

  • What is In-toeing and out-toeing?

    In-toeing and out-toeing is a health condition that affects how part of the body functions, and can range in severity from mild to significant depending on the individual. A clinician can assess your specific situation and explain what it means for you. Understanding the basics helps you ask the right questions at your appointment.

  • What leads to in-toeing and out-toeing?

    There are usually several contributing factors behind in-toeing and out-toeing, and it's not always possible to pin down a single cause without proper assessment. Your doctor will consider your symptoms, history, and any relevant investigations to build a clearer picture. This helps make sure treatment is targeted appropriately.

  • How would I know if I have in-toeing and out-toeing?

    Symptoms can vary from mild and barely noticeable to more significant and disruptive, depending on severity and individual factors. Common features often include changes that affect comfort, function, or general wellbeing in the affected area or system. If you're experiencing symptoms that concern you, it's worth having them assessed rather than guessing.

  • How worried should I be about in-toeing and out-toeing?

    Most cases can be managed effectively once properly assessed and treated, though how serious it is depends on individual circumstances and how early it's picked up. Getting a professional opinion helps rule out anything more concerning and puts your mind at ease either way. Don't hesitate to seek advice if something feels wrong.

  • Is in-toeing and out-toeing hereditary or genetic?

    Some cases have a genetic or family component, while others are linked more to lifestyle, environment, or other health conditions. Having a family history may increase your risk slightly, but it doesn't mean you'll definitely develop it. A clinician can advise whether genetic factors seem relevant in your particular case.

  • Is there a cure for in-toeing and out-toeing?

    Treatment can often reduce symptoms significantly and, in some cases, resolve the underlying problem entirely, though this isn't guaranteed for everyone. Prevention strategies, where they exist, usually focus on managing risk factors and general health. A tailored discussion with your doctor will give you the clearest picture for your circumstances.

  • How is in-toeing and out-toeing treated?

    Treatment options range from conservative measures such as lifestyle changes, medication, or physiotherapy through to more involved interventions in more severe or persistent cases. The right approach depends on the underlying cause, severity, and how it's affecting you. Your specialist will talk through the pros and cons of each option that's relevant to you.

  • What is the typical recovery time for in-toeing and out-toeing?

    Some people recover within a matter of weeks, while others find it becomes a longer-term or recurring issue that needs ongoing management. Following your treatment plan closely tends to support the best possible recovery. Ask your specialist for a realistic timeline based on your own results and progress.

  • When is a specialist opinion or surgery needed for in-toeing and out-toeing?

    A specialist opinion is generally recommended if symptoms persist despite initial treatment, if they're severe, or if there's uncertainty about the diagnosis. Surgery or more invasive treatment is usually reserved for cases where conservative measures haven't worked. Your GP can refer you on if they feel a specialist review would be helpful.

  • When should I see a doctor about in-toeing and out-toeing?

    See a doctor if symptoms are persistent, worsening, or affecting your daily life, or sooner if you have any red-flag symptoms your GP has warned you about. Waiting times through the NHS often run to 20-45+ weeks for a routine referral, whereas a private specialist can usually see you within roughly 2 weeks.