Surgery is the only intervention that can alter the shape of the lower limbs in a child with in-toeing or out-toeing. Braces, special shoes and physical therapy aren't effective.

In the surgery, the thighbone (femur) or other bones of the leg (the tibia and the fibula) are cut and rotated so that the feet align properly. Metal implants — typically pins or a plate and screws — keep the bones in place while they heal in their new orientation.

This type of surgery is called rotational osteotomy. It's a major operation that comes with a risk of complications. Complications may include:

  • Bleeding and Infection — These risks commonly are associated with orthopedic operations.
  • Implant Failure — The metal implants can dislodge from the bone. When this happens, the correction is lost and the implants must be replaced.
  • Injury to the Blood Supply to the Hip — While this occurs in well under 10 percent of the children who undergo surgery, it can have devastating consequences to hip function, including painful arthritis and stiffness.

Although surgery is the only way to change severe in-toeing or out-toeing, the benefits have to be carefully weighed against the risks for each child.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers


Orthopedic Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 353-2967
Fax: (415) 353-2299
Appointment information