Some children may experience in-toeing or out-toeing. In-toeing is when feet turn inward while walking. This condition is sometimes called “pigeon-toe.” Almost all toddlers who in-toe go on to run, jump and play the same as other kids.

Out-toeing is when a child’s feet turn outwards when they walk—a condition also known as “duck feet.” This condition is less common than in-toeing.

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What are the signs and symptoms of in-toe or out-toe?

There are different symptoms depending on whether a child in-toes or out-toes:


  • Walking or running with feet pointed inward
  • Awkward walking or running possible
  • May cause tripping or falling


  • Walking or running with feet pointed outward
  • Awkward walking or running possible
  • Possible limp
  • Possible pain in the hip, thigh, knee, or foot

What causes in-toeing or out-toeing?

There are several possible causes of in-toeing and out-toeing:


  • Slight twist in shin bones causing feet to turn in
  • Slight twist in thigh bones causing feet to turn in
  • Curved feet causing toes to point in


  • External rotation of the hip
  • Shin bones twisting outward
  • Family history of out-toe
  • Flat feet

Less common causes of out-toeing include thigh bones twisting outward, a diagnosis of Legg-Calvé-Perthes or a diagnosis of cerebral palsy.

How is in-toe or out-toe diagnosed?

  • Physical exam
  • X-rays if necessary

It is important to make an appointment with your child’s doctor to rule out an underlying cause for your child’s in-toe or out-toe.

How are in-toe and out-toe treated?

Treatment depends on the cause and the extent of your child’s condition. For many children, in-toe and out-toe resolve on their own without treatment. Surgery is only needed in cases where your child’s condition leads to pain or problems with walking and running.

Doctors at Connecticut Children’s can determine the right plan to treat your child’s in-toe or out-toe.