Clinical Practice and
Referral Guidelines


In-toeing is defined as when the feet turn inward instead of pointing straight ahead during walking or running. The guideline was developed to assist the pediatrician in the evaluation of in-toeing and to determine when a referral to a pediatric orthopedist is warranted.    

This guideline includes the following:

  1. Description of the three most common conditions leading to in-toeing which include metatarsus adductus, internal tibial torsion and femoral anteversion;
  2. History and physical exam recommendations and standards.
  3. Referral guidelines; and
  4. Treatment options which may include an exercise regimen, special shoes, serial casting, or in rare cases, surgery.   

If you are a physician and would like more information on the Clinical Practice and Referral Guideline for in-toeing, please contact us at

If you are a parent and concerned your child may have a condition resulting in in-toeing, please consult with your child’s pediatrician or primary care physician.

This guideline was developed in collaboration with pediatric orthopedists from Georgia Pediatric Subspecialists. The recommendations in the  guideline do not indicate an exclusive course of treatment. The intent is to build a consensus of care in the pediatric community and provide a framework for clinical decision-making. Last revised 6/2011.

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