Intoeing AKA Pigeon Toes

Causes and Treatment of "Pigeon Toes" in Children

What Is Intoeing?

When a child’s feet point inward instead of straight, it is known as intoeing. Also known as being pigeon toed, the condition is fairly common, and mild cases will generally resolve on their own.

However, not all cases fall into the “mild” category, and early interventional treatment is recommended, especially when identified in infancy with no noticeable improvement over a period of time.

Your child may start out walking this way or the condition may develop at a later date. Intoeing is painless. However, pain may be associated with the issue that caused the condition.

An Overview of Pediatric Intoeing by Dr. Jarman

What Causes Intoeing?

"Intoeing creates a lot of parental concerns and is a very common torsional gait abnormality I see almost every day here in the office. Intoeing is a visual effect of an underlying torsional twisting deformity coming from the lower extremities."

Dr. Mikkel Jarman

There are three influencing areas of origin, and the classifications are:

  1. Femoral Anteversion – originates from a torsional pull from the hips, causing the child’s knees and feet to turn inward and have a “pigeon-toed” appearance. 
  2. Tibial Torsion – originates from a torsional pull from the lower legs (shinbone), causing the child’s legs and feet to turn inward.
  3. Metatarsus Adductus – originates from the feet, the front half or forefoot, and is a common foot deformity typically visible at birth.

(Read on for a more detailed overview of each classification below.)

Intoeing Illustration
Intoeing Photo credit: achesandjoints.org

The 3 Main Intoeing Classifications

Femoral anteversion

The inward turning of the thighbone, known as femoral anteversion, does not usually become obvious until the child reaches school age. The condition nearly always corrects itself by the age of 9 or 10.

This is another instance where conservative treatment does not correct the issue. If your child has femoral anteversion coupled with severe deformity or gait issues, surgery may be considered after age 10. It requires cutting the femur (thigh bone) to rotate it to the correct position.

child intoeing example of femorial anteversion
When evaluating a child walking, if their knees are pointing in, then there is a suspected influence coming from femoral anteversion.

Tibial torsion

If the lower leg twists inward, this is known as tibial torsion. The condition typically improves gradually, with normal alignment occurring by the time the child starts school.

Tibial torsion does not respond to conservative treatment, e.g. splints, physical therapy, or special footwear. If the child reaches their eighth birthday without improvement and experiences significant walking problems, your podiatrist may recommend surgery. This involves rotating the shin bone to its proper position.

child intoeing example of tibial torsion
When evaluating a child walking, if their knees are pointing forward while their toes are pointing inward, then this could be tibial torsion.

Metatarsus adductus

In a child with metatarsus adductus, the foot bends inward from the midpoint to the toes. The condition may be mild, meaning the foot is still flexible, or rigid.

Typically, the condition corrects itself by the time the child reaches 6 months. In the case of severe rigidity, casting and special shoes typically resolve the problem. Surgery is rarely needed.

Although severe cases of metatarsus adductus may resemble clubfoot, they are not the same. Clubfoot nearly always requires treatment very soon after the child is born.

child intoeing example of metatarsus adductus
When evaluating a child's feet, if the front of their feet are pointing in and knees are straight, then this is most likely metatarsus adductus.

"When evaluating your child, If the knees are pointed forward during gait, then this is either a tibial torsion or a metatarsus adductus. To differentiate these, have the child sit in a chair and look at the bottoms of their feet.If you notice that their foot curves in, then most likely they have metatarsus adductus. In general, we find that children under the age of one, the most common culprit of intoeing seems to come from metatarsus adductus. In children between the ages of one and two, we commonly see tibial torsion as the predominant condition influencing intoeing. Femoral anteversion will often manifest in children older than four."

Dr. Mikkel Jarman
pediatric intoeing toddler demonstrating metatarsus adductus
To determine between tibial torsion and metatarsus adductus, have your child sit and observe the bottom of their feet. If you notice the top of the foot curves in, then this is most likely metatarsus adductus.
Dr. Mikkel Jarman pediatric podiatrist

All content on PediatricFootAnkle.com is written by or collaborated with Dr. Mikkel Jarman and meets our strict editorial guidelines which include fact checking and peer review. Learn more about our website content and resources policies here: Our Website Content & Resources Policy

When to Call Dr. Jarman

As stated above, intoeing is very common, particularly when children first begin walking. The condition nearly always corrects itself as your child grows.

Of course, if you’re worried about your child’s gait, it never hurts to schedule a consultation with Dr. Jarman. And if your child experiences pain when walking, talk to your pediatric podiatrist right away.

review by stephanie

ONE OF THE BEST DOCTORS I HAVE EVER MET!! I am not sure where to even start to describe how thankful I am for Dr. Jarman's services. My daughter who is now 4 years old had issues with her toes pointing inward ( pigeon toed ) since she started walking. As she got older the I noticed that it started getting worse. When she was around 2 1/2 years of age I finally decided to take her to a pedicatric ortho doctor who was recommended by her pediatrician. The ortho doctor told me that it was something she would just grow out of and that there was nothing we could do as far as conservative treatment. After that visit I was somewhat shocked, but also very hopeful that he was right and that through time she would get better. Time went on and my daughter actually started getting worse. At this point her feet were causing her to fall pretty often. I then took her to a different pediatric ortho and was told the exact same thing as the previous ortho. When that happened I did some research and came across Dr. Jarman. After reading that not only does he specialize in the condition of being pigeon toed, but he also dealt specifically with children. I took my daughter to see Dr. Jarman and not only did he confirm that she did have a severe case of her toes being pointed inward, but that there was conservative treatment available. Dr. Jarman also diagnosed and treated my foot problem. Not only is Dr. Jarman thorough, but he also has very good bed side manner and makes you feel like your one of friends.

Stephanie

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