Families must be reassured about the natural history of rotational variations in the femur and tibia. Most children will simply outgrow their variant. An orthopedic or neurologic evaluation should be made if a child has severe in-toeing or an unsteady gait (especially while running), causing stumbling as the toes catch on the back of the trailing leg. A referral may also be advised if a child's condition does not follow the expected physiologic progression with growth.[13] [14]