Pediatric In-Toeing (Pigeon Toes)
Symptoms, Causes and Treatment of Pigeon Toes / In-Toeing 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?
There are three influencing areas of origin, and the classifications are:
- 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.
- Tibial Torsion – originates from a torsional pull from the lower legs (shinbone), causing the child’s legs and feet to turn inward.
- 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.)
The 3 Main Intoeing Classifications
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.
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.
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.
In-Towing (Pigeon Toes) FAQ's
In-toeing is typically caused by internal tibial torsion, femoral anteversion, or metatarsus adductus. These conditions cause the feet to turn inward. Sometimes the cause is unknown.
Mild in-toeing usually doesn’t cause problems. If severe, it can increase risk for tripping and falling. Long-term risks include abnormal wear on joints.
In-toeing typically develops between ages 1-3 as toddlers begin walking. The feet turn inward when walking, giving a pigeon-toed appearance.
Mild cases require no treatment as the child eventually outgrows it. Bracing or casting may be used for more severe cases to gradually straighten the feet. Surgery is rarely needed.
Yes, physical therapy provides stretching, strengthening exercises, and gait training that can help improve alignment and foot position over time in children with in-toeing.