From the Guidelines
In-toeing in a 3-year-old typically doesn't require specific treatment as it often resolves naturally with growth. Observation is the recommended approach for most children, with regular monitoring during routine check-ups. No medications are needed for this condition. If the in-toeing is causing frequent tripping or affecting walking ability, simple exercises might help, such as encouraging the child to sit in a "W" position less often and promoting activities that strengthen leg muscles like running, jumping, and climbing. Special shoes, braces, or orthotics are rarely necessary and haven't been proven effective for typical cases. Physical therapy is only recommended in severe cases that affect function. Parents should understand that in-toeing occurs because of natural variations in bone alignment or muscle development, and about 80% of cases resolve by age 8 without intervention. If the condition is severe, causes pain, or doesn't improve with time, consultation with a pediatric orthopedic specialist may be warranted. The provided evidence does not directly address the treatment of in-toeing in children, but general medical knowledge suggests that observation and simple exercises are often the best course of action 1.
From the Research
Treatment Options for Intoeing in 3-Year-Olds
- Intoeing, also known as internal rotation of the long axis of the foot, can be caused by various factors, including primary deformities within the foot, issues with tibial torsion, and femoral antetorsion (anteversion) 2
- Treatment for intoeing must be individualized, and the risks and complications weighed against the predictable morbidity of intoeing 2
- For idiopathic toe walking, treatment options include observation, physical therapy, serial casting, or Achilles tendon lengthening surgery 3, 4
Serial Casting as a Treatment Option
- Serial casting has been shown to be effective in treating idiopathic toe walking in young children, with improvements in ankle range of motion and gait 3, 5
- A study found that serial casting increased passive ankle dorsiflexion to 10° of neutral and established a heel-toe walking gait in an 18-month-old child 3
- Another study found that serial casting followed by ankle-foot orthosis use improved kinematic, spatial, and temporal parameters of gait in a child with autism spectrum disorder 5
Age-Related Considerations
- Intoeing is a common complaint in infants, toddlers, and young children, and its prevalence decreases with age 2, 6
- A large cohort study found that foot progression angle (FPA) changes over the course of a child's development, with a spontaneous shift towards moderate external rotation between ages 2-4 6
- The study also found that bilateral in-toeing after the age of four and unilateral in-toeing after the age of seven should be monitored 6
Other Treatment Options
- Other treatment options for intoeing include physical therapy, bracing, and surgery, although the effectiveness of these options may vary depending on the individual child and the underlying cause of the intoeing 2, 4
- A systematic review found that the certainty of evidence for interventions for idiopathic toe walking is generally low, and further research is needed to evaluate the effectiveness of different treatment options 4