Tibial torsion refers to a twist in the tibia which is the main bone in the lower leg. This develops before birth as the baby grows inside the small space of the uterus. Most often, this involves “in-toeing." This means the feet point toward one another when the knees are bent. Much less common is “out-toeing” where the feet turn away from one another. Some degree of tibial torsion is normal during infancy. It may affect one leg more than the other.
When the child starts to stand and then to walk, the tibial torsion starts to correct itself naturally. For in-toeing, this usually occurs 6 to 12 months after the child starts to walk. This self-correcting process continues during childhood and by age 7 to 8 years most children have corrected their tibial torsion without any special treatment. Out-toeing is less likely to correct itself, but it usually does not cause long-term problems.
In the past, standard treatment for in-toed tibial torsion was special orthopedic shoes connected by a bar. This was worn at night to hold both feet in a toe-out position. But it was later learned that children recovered from tibial torsion just as quickly whether or not they wore this splint. So now, the splint is no longer used and most children do fine.
If the feet still turn in more than 15 degrees by 5 years of age, that is a sign that they might not self-correct and surgery may be needed. However, surgery for this problem is usually delayed until the child is between 7 to 10 years old.
Follow up with your healthcare provider or as advised. Periodic measurements by your doctor can follow the self-correcting response.
When to seek medical advice
Call your healthcare provider if you have concerns about your child's development or if the child is over 5 years old and his or her feet still turn in more than 15 degrees or if pain occurs.