This problem is not a diagnosis but rather a complaint that usually concerns the parents and results in a visit to the foot specialist. The most important aspect in treating this problem is for the clinician to identify the source of the deformity. A child walking with their feet pointed inward may be caused by a pathological problem within the foot or deviations in normal development in the hip or leg.
There is a controversy among medical professionals as to the necessity in treating this deformity. One school of thought is that treatment is not necessary and that the child will eventually outgrow the problem and that any improvement seen in the treatment of the condition is actually the natural resolution of the problem.
Other experts regard pediatric intoeing as an alteration in normal development that can become pathological.
The history of the complaint can be very helpful in pinpointing the source of this inward gait. The age of the child when the condition is first noticed can go a long way in determining the origin of the problem.
AN INWARD GAIT AT BIRTH is usually the result of a problem directly within the foot.
Hallux varus (where the big toe is pointing away from the second toe).
Pes cavus(high arched feet) may all contribute to this problem.
AN INWARD GAIT AT ONE TO TWO YEARS is usually a result of an abnormality in the alignment of the upper or lower leg.
Tibial torsion- the lower leg is twisted inward forcing the foot to twist inward as well.
Femoral anteversion- the thigh turns inward and one will notice that not only is the foot twisted inward, but the knee is pointing inward as well.
AN INWARD GAIT BEGINNING AROUND 18 MONTHS may be the result of abnormality in the pelvis or hip region.
One other very important aspect of the child’s history is their neurological status. Factors such as bleeding during early pregnancy, premature labor, difficulty in delivery, and intracranial hemorrhage may all lead to neurological disturbances in the newborn which may manifest itself in one way with intoeing. Neurological disturbances causing this problem will not spontaneously correct itself and more than likely will worsen over time.
If the neurological status is normal then most likely the cause for intoeing is a skeletal abnormality.
It is beyond the scope of this article to discuss treatment for an inward gait as a result of deformity outside the foot.
Most intoeing problems that originate in the foot are congenital meaning they are present at birth. Inspection of the foot alone, at birth, is usually all that is needed to make this diagnosis. As previously noted there are four conditions within the foot that can cause intoeing the most common is metatarsus adductus. The rest of this discussion will deal with this condition.
The diagram below (left) demonstrates feet that are directed inward. The problem with this type of deformity is that once the child starts to walk, he or she will have a tendency to trip over their foot (if the condition is severe enough) and the parents will notice that the child is falling more than other children of similar age.
The diagram above (right) shows the skeletal difference between a normal foot on the left and metatarsus adductus on the right.
TREATMENT OF INTOEING
The treatment of choice for metatarsus adductus is serial casting where a cast is applied to the foot and leg in an effort to gently straighten the front of the foot relative to the back of the foot. New casts are applied on a regular basis relative to the amount of improvement noted each time.
The ideal time to institute serial casting is around six months of age, although casting may be beneficial up to two years of age. After age two the success rate drops dramatically. At that point the use of special shoes and splints may be indicated but their success rate is controversial.
At one point in time surgical intervention was popular for metatarsus adductus. The main procedure was a soft tissue procedure where ligaments were released in order to allow the forefoot to straighten out. It is not used much today because one of the complications was arthritic changes in the joints where the ligaments were released.
The other surgical option, which is still in use today is abducting metatarsal osteotomies where the metatarsal bones are surgically broken and re-angulated in an effort to straighten out the forefoot. This surgery is reserved for very severe cases of metatarsus adductus.
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Great article. I have had plantar fasciitis since I was in high school……..
Dear Dr. Mitnick,
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Thanks for the Response, you hit it on the head.
Redondo Beach, CA
Thank you for your time and expertise in answering my question…..
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Last June I started having pain and swelling at …….
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Thanks Very Much,
West lafayette, IN
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Tampa, Florida 33624
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Michael D. Ebeling
Tampa, Florida 33624
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Mansfield Ctr, CT
First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.
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Pacific Grove, CA
I used to work for a podiatrist (front desk) back during summers in
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All the best,
By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!
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Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain......
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I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.
1st of all THANKS A LOT for your great site......
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!
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San Clemente, CA
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Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.
Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!
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I just wanted to say that I am very greatful for
Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.
Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.
Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM.
Excellent information and help to improve One's life.
Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!
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Thank you very much for the information, I will consider it. Excellent web site.
San Diego, CA
Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better.
So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!
Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,
THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.
thanks again, this site is very helpful.
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....Keep up what your doing. Your a life saver.
Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.
This is the best site for foot problem info.
Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.
I just wanted to say that I am very greatful for
this website!! I have had a fusion in my rt foot
and am finally getting a little bit better......
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!
Thank you for your response. You have provided some great insight (to my question)....
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!!
This website is terrific!!!!
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...
Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.
Dear Dr. Mitnick,
Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,
Your webpage is excellent, I commend you on sharing your knowledge to the public.
Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.
I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!
Thank you so much Doc for a quick and thorough response!
I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!