Doctors have different ideas about when the casts should be put on, but many think that if the feet are still curved when the child is four to six months old, casting should be started. The casting should be finished before the child reaches normal walking age. If the feet still have some curve after the casting treatment, that will not cause any problems with running and playing, and is never painful. A strong curve can cause problems with fitting shoes, and this is the main reason for using casts. Internal tibial torsion is a twist in the tibia , the leg bone between the knee and the ankle, as shown in the drawing.
Parents usually notice internal tibial torsion about the time the child begins to walk.
Some inward twist of the tibial bone is normal in babies. Usually this twist straightens out during the baby's first year. In some children, the twist doesn't get straight enough that their feet point straight ahead or outward, and these are the children who still intoe when they begin walking. Leg bones usually continue to grow straighter until the child is six to eight years old. Braces and special shoes are not very helpful.