In-toeing, out-toeing and flat feet in children

What it is

These are the lower limb problems that bring a mother to the clinic. In-toeing is a gait in which the toes point inward and the walking looks clumsy; out-toeing and flat feet are the other two. Flat feet, pes planus, sits among the foot disorders alongside congenital talipes equino varus, pes cavus and hallux valgus.

Causes and risk

In-toeing gait has three main causes:

• Femoral anteversion
• Internal tibial torsion
• Metatarsus adductus

Out-toeing is attributed to hypermobility and to the Ehlers–Danols and Marfan syndromes. Flat feet are attributed to hypermobility and to congenital tarsal fusion.