Question

My 12-week-old twin boys were born 6 weeks prematurely. The older one has bowed legs and severely turned-in feet. The bone on the outside of his ankle looks as if it's growing crookedly. We go for our developmental checkup next month. Our pediatrician doesn't seem too worried about it, but I'm afraid that nothing will be done until the other one is crawling and walking and he can't. What should I do?

Answer

In the later stages of pregnancy, the uterus is cramped for space, and babies are sometimes born with the feet and lower legs twisted inward. This is certainly more common in twin pregnancies, and one twin may be more affected than the other. The legs and feet relax somewhat over the first weeks of life, but more severe cases may take longer. Your question notes two specific problems. Turned-in feet correct themselves spontaneously as long as the feet can move to a straight position with gentle pressure. The foot should also move freely about the ankle in all directions, again with gentle pressure. If the foot does not straighten easily and move about the ankle freely, your baby may have some degree of clubfoot. Clubfeet may require casting or surgery. You also mention bowed legs, which can also occur in the newborn as a result of cramped space during the later stages of pregnancy. The ankle and knee joint should have full range of motion, but you may not be able to straighten the shin bones. This is called tibial torsion and usually goes away after the baby has been walking for several months. The growth and strengthening of the bones and muscles in the lower leg while walking helps tibial torsion disappear on its own. Your baby's health care provider should perform a detailed examination of your baby's legs and feet at each well checkup. If everything is fine, the provider will offer you reassurance and count on your patience to let nature take its course.