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February 26, 2026

Will In-Toeing Affect My Child’s Gross Motor Skills?

Although in-toeing is a common problem among children, very few require more than physical therapy intervention. Orthopedic conditions like metatarsus adductus and femoral anteversion can contribute to in-toeing. However, most in-toeing is often due to moderate strength deficits.

This blog will explore the causes of in-toeing and discuss tips to use at home to decrease in-toeing. If you are ever concerned about your child’s gross motor development, contact their pediatrician and inquire about a physical therapy referral.

 

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Causes

 

1. Femoral anteversion

  • Condition in which the thigh bone is more internally rotated on the pelvis. Child often favors a W-sitting position, resulting in increased internal rotation mobility of the hip.
  • If spontaneous, often resolves by age 8.
  • If due to neurological abnormality, there is a lower incidence of  spontaneous correction.

 

 

2. Metatarsus Adductus

  • A condition in which the forefoot (front part of the foot) is turned inward in comparison to the hindfoot (back part of the foot).
  • Children 3 and under have a more flexible foot in which early intervention with stretching and strengthening may help.
  • After age 4, the foot becomes ossified (meaning the bones have hardened) and more rigid.

 

3. Moderate strength deficit

  • Glute strength can be a large contributor to in-toeing. Glute muscles function to help with external rotation (turning the foot/hip outwards). 
  • When these muscles are weak, in-toeing may become more noticeable.
  • A balance of internal rotator and external rotator (glute) muscles assists in maintaining neutral (straight) foot alignment when walking.

 

4. W-sitting

  • Children sitting on their bottom with their knees bent and legs splayed outward, resembling the letter “W.” 
  • Sitting in this position increases the mobility in the hip into internal rotation (turning inward), increasing the possibility of in-toeing.

 

Tips


o Avoid w-sitting: This is a very common position for kids to play in. However, we want to avoid it because it increases the amount of internal rotation (turning inward) in the hips to a greater extent than normal. Consistent sitting in this position can contribute to in-toeing and hypermobility.


o Use both legs when climbing, navigating stairs, or surface changes. Many children develop a side preference to lead with when climbing or stepping up/over objects. By practicing both sides, it will improve their lower extremity strength and symmetry to be able to perform most tasks with either leg.

o Practice stepping over objects of different heights to focus on foot clearance to decrease the frequency of tripping.


o Practicing glute strengthening activities such as bridges or standing on one leg can frequently help improve glute strength to reduce in-toeing.

 

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Overall, should I be concerned about my child’s in-toeing?


Although in-toeing may correct spontaneously and is not necessarily a “fixed” condition, it affects your child’s gait and function throughout their everyday life. It can lead to increased tripping and falling more than typical for your child. You may also note that your child is unable to keep up with their peers.With a little bit of practice and strengthening, your child’s in-toeing will likely improve as they grow. If you have any questions, don’t hesitate to reach out to your doctor for a physical therapy referral.

 

 

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