From the Research
In-toeing in a 2-year-old child typically requires observation rather than active intervention, as most cases resolve spontaneously by age 8 without specific treatment. Parents should be reassured that this condition, often called "pigeon-toed" walking, is a normal developmental variation that rarely causes functional problems. The condition usually stems from one of three causes: metatarsus adductus (curved foot), internal tibial torsion (twisted shin), or femoral anteversion (twisted thigh bone), all of which represent normal variations in skeletal development that typically correct as the child grows and the musculoskeletal system matures 1.
Key Considerations
- No medications, special shoes, braces, or exercises are routinely recommended for typical cases 2, 1.
- Children should be encouraged to engage in normal play and physical activities without restriction.
- Regular well-child visits are sufficient to monitor progression.
- Medical evaluation is only necessary if the in-toeing is severe, asymmetric, associated with pain, causes frequent tripping, persists beyond age 8, or is accompanied by other developmental concerns.
Evidence-Based Approach
The most recent and highest quality study on this topic is from 2017, which suggests that lower extremity abnormalities, including intoeing, are common in children and usually resolve spontaneously as the child grows 1. Another study from 2014 found that surgical correction of internal tibial torsion can improve gait function in children with persistent intoeing gait, but this is typically only necessary in severe cases 3.