Definition

Intoeing is defined as an abnormal angle of gait with the toes pointed excessively inward. This commonly occurs in children of various ages. The rotational (transverse plane) pathology producing this deformity can occur at the level of the hip, knee, tibia or foot.

Overview

Although there are persistent claims that intoeing will resolve on its own, failure to reduce the transverse plane rotational pathology on the talus can lead to persistent excess pronation issues. Numerous studies have linked the persistence of torsional problems with the development of arthritic changes. Since intoeing is often compensated by excess subtalar joint (STJ) pronation and excess midtarsal joint (MTJ) mobility, it may make sense to prevent the compensation with orthoses in order to prevent future problems.

There is some evidence that orthoses can reduce tripping and prevent compensatory damage to the feet. In one study, using gait plate (orthoses designed to limit transverse plane abnormalities) resulted in a significant reduction in the amount of intoeing and reduced the frequency of tripping. Parental satisfaction was high or very high, suggesting that this intervention warrants further investigation as an alternative to “observational management” for symptomatic intoeing.¹

Clinical Goal for Orthotic Treatment

The orthosis for the child with intoeing gait should limit intoeing in order to increase stability, decrease tripping and prevent pronatory compensation and subtalar subluxation.

Prescription

To prescribe this device check “Intoeing Gait (gait plate)” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Intoeing Gait Prescription Recommendations

• Polypropylene Shell – semirigid with gait plate extension
  • The shell of the orthosis extends past the 4th and 5th metatarsal heads, making it necessary for the child to externally rotate their lower extremity and abduct their feet in order to propel forward.
• Standard Heel Cup
  • If the RCSP is everted, prescribe a deep heel cup to control rearfoot eversion
• Wide Width
  • A wider width through the arch increases the surface area under the arch to provide additional support of the midfoot.
• 0/0 Rearfoot Post
  • The rearfoot post stabilizes the orthosis inside the shoe

Summary

The intoeing gait orthosis is designed to restrict motion of the 4th and 5th metatarsophalangeal joints and to prevent pronatory compensation by supporting the arch and preventing heel eversion. If you have further questions about orthoses for this challenging condition, ProLab clients can contact a Medical Consultant.

References

1. Redmond AC. The effectiveness of gait plates in controlling in-toeing symptoms in young children.  J Am Podiatr Med Assoc.  Feb;90(2):70-6, 2000
2. Redmond AC. An evaluation of the use of gait plate inlays in the short-term management of the intoeing child.  Foot Ankle Int. Mar;19(3):144-8, 1998
3. Levitz S, Sobel E. An evaluation of the use of gait plate inlays in the short-term management of the intoeing child.  Foot Ankle Int. Aug;19(8):573-4, 1998
4. Ikeda K. Conservative treatment of idiopathic clubfoot J Pediatr Orthop. Mar-Apr;12(2):217-23, 1992
5. Cheng LX, Fabry G, Van Audekercke R, Molenaers G. Ground reaction torque and pathway of point of application of ground reaction force during gait of intoeing children. Foot Ankle Int. Aug;16(8):510-3, 1995
6. Liu XC, Fabry G, Van Audekercke R, Molenaers G, Govaerts S. The ground reaction force in the gait of intoeing children.  J Pediatr Orthop B. 4(1):80-5,1995
7. Kirby K. Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast 23-24, 1997
8. Schuster RO. A device to influence the angle of gait. J Am Podiatry Assoc. 57(6):269-270, 1967
9. Jordan RP. Therapeutic considerations of the feet and lower extremities in the cerebral palsied child. Clinical Podiatry 1(3) 547-561, 1984
10. Volpe R. Evaluation and management of intoed gait in the neurologically intact child. Clinical Podiatric Medicine. 14(1) 57-85, 1997