What are the treatment options for intoeing (in-toeing) gait in a 12-year-old child?

From the Guidelines

Treatment for intoeing gait in a 12-year-old child should focus on observation, conservative management, and physical therapy, as most cases resolve naturally with growth, and surgical intervention is rarely needed unless significant functional problems or pain are present. When considering treatment options, it's essential to identify the underlying cause of intoeing, which at this age may be due to femoral anteversion, tibial torsion, or metatarsus adductus 1. Key aspects of conservative management include:

• Stretching exercises for tight muscles
• Strengthening exercises for weak muscles
• Gait training to improve walking mechanics Custom orthotics or shoe inserts may also be beneficial in providing better foot alignment and support. In more persistent cases, night splints or braces might be recommended to gradually correct the rotation while sleeping. Regular participation in activities that promote proper foot positioning, such as swimming, bicycling, or skating, can naturally improve alignment. It's crucial to reassure the child and their family that most cases of intoeing do not cause long-term problems and often improve with continued skeletal growth through adolescence. Referral to a pediatric orthopedic surgeon may be considered if the condition causes significant functional problems or pain, as they have the specialized training to address complex musculoskeletal issues in children 1.

From the Research

Treatment Options for Intoeing Gait in Children

The treatment options for intoeing gait in children can be divided into conservative and surgical methods.

• Conservative management options include:
  • Braces
  • Wedges
  • Stretches and exercises
  • Shoe modifications
  • Orthotic devices with a gait plate extension
  • Gait plates
  • Physiologic/standardized shoes
  • Lateral sole wedged shoes as reported in studies 2, 3
• Surgical management options include:
  • Supramalleolar tibial rotational osteotomy
  • Tibial rotation osteotomy as reported in studies 4, 5

Effectiveness of Treatment Options

The effectiveness of these treatment options varies:

• Gait plates, physiologic/standardized shoes, and orthotic devices with a gait plate extension have been shown to produce a statistically significant improvement in intoed gait pattern 2
• Lateral sole wedged shoes and gait plate insoles have been shown to improve the foot progression angle in children with intoeing gait 3
• Supramalleolar tibial rotational osteotomy has been shown to improve kinematic and kinetic gait deviations associated with intoeing gait 4
• Tibial rotation osteotomy has been shown to provide effective correction of excessive internal tibial torsion and normalization of the internal foot progression angle in patients with talipes equinovarus deformity 5

Long-term Outcomes

Long-term gait outcomes following conservative management of idiopathic toe walking have been explored, and significant improvement in ankle kinematic timing and ankle kinetic gait analysis variables has been found 6