Concerns about gait and leg alignment in children are common. It's hard to tell when to worry and when to just be reassured. We asked pediatric orthopedic surgeon David Roberts, MD, of NorthShore Orthopaedic & Spine Institute, to break down four of the most common gait and leg alignment concerns in children and when you need to do something.

In this first of a four-part series, we look at intoeing.

Intoeing means that when a child walks or runs, the feet or knees point inward instead of straight ahead, and is caused by differences in the inward rotation of bones in the thigh or lower leg.

Most children have no pain or symptoms, but the appearance may be concerning to parents.  There may be an awkward appearance when the child walks or runs, and they may also sit differently, in a W-position with the knees in and feet out to the side.

Fortunately, most children grow out of this on their own. Intoeing from the lower leg usually resolves by age 4-5, whereas intoeing from the hip/thigh takes a bit longer to resolve, by age 8-10.

Whether to worry depends on your child’s age. If your child is younger than age 10, most intoeing will get better without any treatment.  Treatments such as restrictions on sitting position, orthotics or braces, and exercises with physical therapy have not been shown to improve the natural process of correction that occurs with growth.  Nothing is needed other than time, patience, and normal growth of the bones in the thigh and leg.

It may be worth seeing a specialist if the intoeing is severe, diagnosis is unclear, treatment is being considered, or when intoeing is causing pain or associated with developmental delays (e.g. not meeting normal milestones). 

Rarely, some children do not outgrow their intoeing. For an older child (over age 10) with persistent intoeing, evaluation by a specialist is recommended, especially if there are associated symptoms, pain or functional limitations.  In rare cases, corrective surgery may be considered, but fortunately, these situations are less common.

We suggest seeing a doctor about your child’s intoeing, if it is:

• Severe – e.g. concerning to your pediatrician, more than what is typically seen
• Painful or disabling – e.g. pain, tripping, falling, or not keeping up with peers or milestones
• Persistent beyond age 10