Pigeon Toes (In-Toeing) Causes and Treatment

Pigeon Toes (In-Toeing): Why It Happens and How It Gets Treated

All parents want their children to grow up healthy. It’s natural to keep a very close eye on your children as they develop, and any sign of irregularity is probably going to worry you. When children start to walk and run, one of the most common issues parents see is an inward twisting of the feet. This is commonly called in-toeing or pigeon toes. There are a few different anatomical issues that can cause this gait, and each one will present itself a little bit differently.

Problems in the Feet: Metatarsus Adductus

When the cause of your child’s in-toeing is a bend in the bones of the feet, the issue is technically called metatarsus adductus. This is the most common cause of in-toeing, and it’s also the most easily detectable. Metatarsus adductus can usually be diagnosed and treated when your child is very young, usually within the first year.

Like all of the anatomical issues discussed here, metatarsus adductus is often a problem that corrects itself over time. Minor cases may be left untreated to let your child grow and develop. A good podiatrist can help you monitor the issue over time and determine whether or not treatment is needed. Corrective footwear can provide plenty of help, and preventative casting is used in more severe cases. Surgical treatment is a last resort, since causing unintended damage to the delicate bones of the foot is a distinct possibility.

Twisted Shins: Tibial Torsion

A gait that turns the feet inward can also be caused by a shin bone (tibia) that twists inward. This condition is called tibial torsion. A certain degree of tibial torsion is absolutely normal; all people are born with the bones of the leg rotated slightly inward. This rotation corrects itself in time as children begin to walk upright. Exceptional tibial torsion may cause the feet to point inwards when your child first starts to walk; the problem is typically noted in the second or third year.

An unusual degree of tibial torsion should be monitored carefully as your child learns to walk. If the problem doesn’t resolve itself within nine months to a year, doctors, and podiatrists can help devise an effective treatment regimen. Braces and casts may be used to correct minor torsion, and a specialized exercise regimen can be provided, as your child grows older.

Intoeing Illustration
Intoeing Photo credit: achesandjoints.org

Additional Causes of In-Toeing

Hip and Thigh Issues: Femoral Anteversion

Sometimes the cause of in-toeing resides at the very top of the legs. When one or both femurs (the thigh bones) are twisted inwards, they can cause the feet, lower legs, and knees to point towards each other. This issue is slightly more common in girls than boys and it usually presents itself between three and four years of age.

Femoral anteversion is the least common of the skeletal issues that cause in-toeing. It can cause significant problems with balance and coordination, but it’s no more difficult to treat than the other causes. Long-term stretching and exercise plans offer excellent results, and most children will see in-toeing caused by femoral anteversion clear up by the age of seven or eight. Bracing may help with very severe cases, and surgery is an option for those who don’t respond to treatment.

In-Toeing Treatments and Long-Term Health

What to do if you have children with pigeon toes.

Being pigeon-toed is usually more stressful for parents than for children who are diagnosed with the issues outlined above! The forms which develop early –often pass without the child even noticing them. Modern podiatrists tend towards a “wait and see” attitude towards inward-turned feet which you may naturally find frustrating. Given the poor track record that aggressive treatments have had in the past, though, a cautious approach is best.

Osteotomy is the surgical treatment used to treat severe cases of in-toeing. The abnormal bones are broken and re-aligned so that they heal straight. There is a vast and disturbing list of possible side effects, from nerve damage to permanent gait problems more severe than the original in-toeing. Today doctors hesitate to even consider surgical correction before age five; it is best left as an absolute last resort.

While taking a close interest in your child’s development is a natural part of parenting, you shouldn’t panic at the first sign of inward-pointing toes. The issue is surprisingly common and it’s self-correcting for the vast majority of children who experience it. Bring the issue to the attention of a good podiatrist so that it can be monitored as your child continues to grow; the most effective treatment is often plain old patience.

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