My child, Stephen, is 15 months old. He is in pretty good health, and weighs around 23 pounds. He started walking about 3-4 months ago, and I noticed that his feet are inward facing, like / \, at about 30 to 45 degrees. Will the situation correct itself as he grows older? Under what kind of situation do I need to see a specialist? Thanks.

Gravity and muscle-use patterns sculpt our bodies over time. Most children begin life with moderate in-toeing. When a child begins walking, both the femur (the large bone in the thigh) and the tibia (the large bone in the calf) undergo a gradual process of external rotation. This remodeling generally continues for 6 to-12 months after the child has been walking fully. If an internal or pigeon-toed gait of a significant degrees persists beyond this point, (/ \) a 'torsional deformity' exists. Torsional deformities are the result of hindering the normal maturational process of external rotation. This hindrance is most commonly genetic, but can be caused by the environment, such as persistent sitting in the reverse tailor or W position (this is the opposite of Indian-style (tailor position), the child sits with the knees bent and the legs angled outward rather than crossed).

A torsional deformity can occur at the foot, the tibia, or the hip. It commonly occurs at a combination of these sites. In-toeing caused by the foot itself is called metatarsus adductus.