Tag Archives: Running

In-toe and Out-toe Walking in Children

If you’re a parent who has noticed that your young child seems to walk with their toes pointing inward, you may be concerned that this “in-toe” walking will affect them as they grow.

You may rest assured that most in-toe walking (and even “out-toe” walking) corrects itself in time.

Also known as walking “pigeon toed,” in-toe walking often is caused by what is known as a femoral ante version, in which the top of the child’s thigh bone (femur) has an inwards twist.

For some children, in-toe walking is caused by an inwards twist to their shin bone (tibia), called internal tibial torsion.

Finally, a very few children with in-toe walking do so because the shape of their feet curve and hook inwards. This is called metatarsus adductus.

You may notice that your in-toe walking child may trip a bit more than children who do not walk in-toe. Again, most children outgrow in-toe walking by the time their around ages 7-8.

If, by chance your child’s in-toe walking is caused by the top of the femur twisting inward (femoral anteversion) and the condition doesn’t correct itself as the child ages, you needn’t worry that your child will not be able to play in sports or be physically active. Some children have a severe twist to their femur (this is very rare) that can cause pain at their knees and hips when they become teenagers. You may think of an operation to correct it.

Most in-toe walking decreases as the child ages and special shoes, braces or splints generally are not necessary to correct the condition.

Naturally, if you have any concerns at all, a health care provider, particularly a podiatrist, will be happy to take a look at your child.

“Out-toe” walking is even less common in children. As with in-toe walking, out-toe walking may be caused by the upper thigh or shin twisting outward. If your child doesn’t walk out-toe and then starts doing so, you’ll need to have him or her see a health professional for x-rays of the “lateral hip view” so that the a “slip” of the hip can be ruled out.

The best treatment for out-toe, as well as in-toe? As with the child who walks in-toe, braces, special shoes, etc. are unnecessary. Simple walking is best and, as time passes, most all in-toe and out-toe walking self-corrects as the child grows.

How to Select your Running Gear

Running/Walking Gear

The well-equipped Walker

Let me ask you a question. What do you need to go on the walk? You probably say, a pair of shoes, a shirt and shorts. But if you’re going to do it right, you need to know that the right gear is very important. Your shoes should be comfortable and help you in staying injury free. Don’t focus on the price of the shoe and how it looks on you. The equipment has to be practical, durable, and comfortable.
Running/walking shoes
in my opinion running shoes should meet particular biomechanical needs. A good running shoe is designed to minimize injury and maximize form and function.
Factors to consider:
– foot type (high arch, flatfoot, normal arch)
– foot strike (heel striker, forefoot striker, mid- foot striker)
– stride pattern (pronator, supinator, neutral)

Buying the right shoe:
Purchase your shoes at a specialty running store rather than a wholesale sporting goods store. Pick a store that caters to the needs of runners, often have a professional and knowledgeable individuals who understand the needs of runners and are familiar with the latest models and brands of shoes. The experts at the stores are trained to match you with a particular shoe that would best for your biomechanical needs. One thing I suggest is that you shop for your shoes later in the day when you feet have swelled to their maximum size. There are many brands of running shoes and they are all equally good. The most important thing is to get the shoe that meets your biomechanical needs and feels comfortable to you.
Try the shoes on with the sock that you will be wearing when walking/running. Stand in the shoes, you need to have one thumb with between your longest toe and the end of the shoe ( have in mind that your longest toe could me your 2nd toe). This will prevent black toenails or toenails that fall off ( toes hitting the end of the shoe). Also, the heels should not slip out of the back of the shoe when walking. Try to take a walk in the shoe store, maybe off the carpet and on to a hard surface ( in the store if the store allows it).

Types of running shoes

Most important factors in choosing shoes are; support, cushioning and shock absorption. Training shoes that are very light weight are designed for experienced runners. However due to their lightweight these shoes don’t offer much protection compared to normal running shoes.

Shoe terminology

The Toe box :

Self explanatory (the toe section of the shoe), there should be about half an inch room between your toes and end of the shoe and top of the shoe.


Shoelaces should not be too long or too slippery. This is what pulls the uppers together and keeps your foot secure.


Material that holds the foot. This material should be breathable fabrics; this will prevent your feet from overheating during exercise/running/Walking. This Material should also be a sturdy material to help stabilize your foot in the shoe.

The tongue:

This should be thick enough to protect the top of the foot from the pressure of the laces but not too long that runs against your ankle.

Heel notch:

Most running shoes nowadays have a slight depression type into the shoe heel collar to reduce heel cord irritation and also to provide a more secure heel fit.

Heel counter:

This is a place where you heel fit securely in the shoe. This part of shoe is very important since an ill fitting heel can cause blisters on your heels. When buying shoes make sure you walk around and see if your heel is not coming in an out of the heel counter.

The sole:

Majority of the shock absorption and cushioning in the shoe is provided by the midsole. This part of the shoe you can not see. There are usually two kinds of midsole foams;

- Polyurethane : denser, heavier and more durable. Mostly heavier runners/walkers do well with polyurethane.

- Eva: softer, more cushion material . This is what most runners use

a good running shoe contains stabilizing technology, devices that reduce overpronation (rolling inward)


Wear and Tear

One of the most important aspects when you are running is how you lace them up. This might sound childish but I have seen many runners/runners with foot pain related to this.

- Heel slippage and top of foot irritation/falling asleep are due to improper lacing. If the top of your foot falls asleep or get irritated, your shoelaces are too tight.

** If your heel slips in and out of the shoe, while the laces are as tight as they can be, you might have a abnormally narrow foot. You might consider shopping for shoes from manufacturers that offer a variety of widths.

Consider Adding Orthotics

Every foot is unique and if you really think about it shoes that fit well and support your biomechanical needs are being mass-produced. Statistics have shown that only 1 out of 4 people have normal walking/running pattern. The other three-fourths have feet that either turn in too much (Overpronators) or not enough (Supinators). These runners are more prone to injury.

Types of orthotics:

- Over-the-counter orthotics: These orthotics are also again mass-produced. These devices come in various sizes ( S,M,L,XL etc..). This may help to some degree, but then again not everyone’s foot is the same. Also consider the fact that the materials used to make these devices are not durable ( might have to change them every few months)

- Custom-made functional orthotics: these devices are usually made by professional foot and ankle specialists. The way I do might functional orthotics for my patients is as follows:

o gait analysis by a digitized gait plate connected to a computer (this data is recorded and gives detail information about different parts of gait cycle)

o Full range of motion analysis of the feet ( this information provides the physician with any limitation of the joints in the foot). Limb length discrepancy is also major factor that I consider.

o Orthotics selection is also very important. We have a variety of orthotics to choose from which will make a difference in comfort and support. Just to name a few component;

§ thickness of the orthotics

§ top cover of the orthotics

§ external/internal heel and Forefoot post

Gait Plate image0101image0142

Running Socks

Running socks are also very important, especially when you’re running or walking for more than half an hour. A good sock will prevent you from developing blisters on your feet. Stay away from cotton socks, these socks keep moisture in and promotes higher friction. There are numerous synthetic fabrics being used today. A good sock should fit well (snug) and Wick away moisture. My favorite sock for running or long distance walking is

“Wright Running Socks”, (Wrightsock)

Have had many people wearing the stock and there are all very happy. The sock will prevent enough cushioning and has an excellent fit. This is a double layered fabric that prevents blisters in most cases. They come in various size and style.