Overview of Gait Disturbances

Gait Disturbances in Children (lntoe-Out-toe)
By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

Children may begin walking with their feet turned in or out excessively, leaving parents with many questions. The problem may be stemming from the foot, leg, knee or hip. Some children may "grow out of it", while others will not.


  • Intoe (femoral anteversion, internal tibial torsion, metatarsus adductus, hyperactive abductor hallucis muscle).
  • Out-toe (femoral retroversion, external tibial torsion, flat feet).


  • Rotational problems often run in families.
  • Intrauterine position during pregnancy.
  • Sleeping and sitting postures may delay the resolution of gait disturbances.
  • Tight muscles and ligaments at any level may contribute to the problem.
  • Bone deformities in the hip, knee, leg or foot can also produce a gait problem.


  • The child is examined at rest, standing, walking and running to determine the level and direction of the deformity.
  • Range of motion of the entire lower extremity and spine is checked, identifying the areas of concern. A "rotational profile" is made.
  • Neurologic problems must always be ruled out.


  • Identify the area of concern.
  • Changing sleeping and sitting position.
  • In most cases, pure observation is all that is needed as many of these conditions will resolve on their own.
  • It may be necessary to cast the extremity to put the tight ligaments and muscles under continuous stretch. This will help to realign the extremity.
  • Orthotics and gait plates in the child's shoe are devices that are used to encourage normal walking.
  • Night braces may be necessary for a short period of time.
  • If a child is tripping or falling and cosmetic concerns exist, more aggressive treatment may be necessary. This may include surgery to realign the lower extremity. This is extremely rare.