We did not always understand all this! Not very long ago, good doctors prescribed all sorts of treatments for bent legs and feet ranging from special shoes to braces to long-term casting. Scientific research has now shown however that these treatments rarely make any difference at all - good or bad! We have therefore become much less "aggressive" about prescribing such treatments in the past 10-15 years. Yes, some doctors still use these traditional but outdated and unnecessary methods - particularly older general orthopedists - but your pediatrician can easily identify those few cases that may really benefit from treatment. In such a case, this office will refer you to a pediatric orthopedic subspecialist who is up to date in the field and who only prescribes treatments which are indeed helpful and necessary.

It is understandable to be nervous about your child's feet, and wanting a second opinion is never unreasonable. If we feel your child doesn't need treatment but you remain unsure, protect your child and yourself from unnecessary pain and expense by going to a pediatric orthopedist in an academic institution such as Children's Hospital or Floating in Boston. (In general, an orthopedist who see's both adults and children is NOT a pediatric orthopedist and will not give you the most informed judgment in these matters. Please feel free to ask us to refer you despite our opinion that treatment is unnecessary - we will be happy to give you the name of a good pediatric orthopedist anyway!

There are 5 areas in which parents often have concerns about feet and legs: flat feet, in or out-toeing, bowlegs, knock-knees and the best choice in shoes.  If you have any other concerns about you child's feet or legs, please feel free to ask.

Out-toeing which APPEARS or DEVELOPS for the first time after infancy is quite unusual and should prompt a thorough investigation for unsuspected injuries, neurologic problems, or bone tumors. Intoeing which emerges beyond infancy is common and almost always benign, however. The cause of being intoed (pigeon-toed) later in childhood can usually be found in either the leg or the hip. Most common is tibial torsion in which the lower part of the leg twists causing the foot to turn in. While tibial torsion is normal in the newborn and usually resolves once the child begins to crawl, walk and stand, it sometimes persists into the preschool years or beyond. It may interfere with running and sports. Traditional treatments for this included braces, special shoes and changing the sleep position: none of these methods have proven to be any more helpful than simple waiting in scientific studies. Treatment or not, the vast majority of cases improve at the same rate and only rarely will torsion persist beyond 6-7 years. Successful correction of those few cases which will not spontaneously resolve unfortunately requires surgery, and a decision about whether this is worthwhile rightly rests upon the degree of impairment in the child's day-to-day functioning. Luckily, rarely is the child severely enough effected by the intoeing to justify such aggressive intervention.

Another cause of intoeing is femoral anteversion - the thigh bones being rotated forward in the hip joint. This essentially postural abnormality is often evident (and is considered normal) in children 1-3 years old, but will occasionally persist into early adolescence. Femoral anteversion is what allows kids to sit in the "tailor" or "W" position, and some argue that this should be discouraged because it promotes persistence of the anteversion. The increased angle where the thigh bone and the hip bone come together will eventually remodel itself without treatment regardless of sitting habits, however, and the child will then no longer toe in.

Overall most cases and causes of intoeing are best treated by time. These processes resolve on their own. Good pediatric orthopedists will usually wait until 9-12 years of age before being concerned about intoeing. Even then few children will need active treatment.