Pigeon toes, or intoeing, describes a condition where your toes turn in while you’re walking or running. It’s more commonly seen in children than in adults, and most children grow out of it before reaching their teenage years. In rare cases, surgery is required. Read on to learn about the causes and symptoms of pigeon toes, as well as how it’s treated.
For many children, pigeon toes develop in the womb. Limited space in the uterus means some babies grow in a position that causes the front part of their feet to turn inward. This condition is called metatarsus adductus. In some cases, pigeon toes occur as leg bones grow during the toddler years. Intoeing present by age 2 may be caused by a twisting of the tibia, or shinbone, called internal tibial torsion. A child age 3 or older may experience a turning-in of the femur, or thighbone, called medial femoral torsion. This is sometimes referred to as femoral anteversion. Girls have a higher risk of developing medial femoral torsion.
In cases of metatarsus adductus, the symptoms are easy to see at birth or soon afterward. One or both of your baby’s feet will be turned inward, even at rest. You may notice the outer edge of the foot is curved, almost in a crescent shape. Internal tibial torsion may not be as obvious until your child starts walking. You may notice that one or both of their feet turn inward with every step. Medial femoral torsion may be noticeable after age 3, but obvious signs are usually present by age 5 or 6. In many cases, the foot and knee both turn in as your child walks. It may also be obvious even when your child stands in place. Children with medial femoral torsion often sit with their legs flat on the floor and their feet out to either side in a “W” shape. There is a related condition called out-toeing. It describes feet that turn outward. The same bone development problems that lead to intoeing can also cause out-toeing.
All three causes of intoeing tend to run in families. A parent or grandparent who was pigeon-toed as a child may pass along this genetic tendency. Pigeon toes may accompany other bone development conditions affecting the feet or legs.
Intoeing can be mild and barely noticeable. Or it can be obvious to the point where it affects your child’s gait. To diagnose intoeing and its likely cause, your doctor will observe your child stand and walk. They should also gently move your child’s feet, feel how the knees bend, and look for signs that a twisting or turning is present in your child’s hips. Your doctor may also want to get images of your child’s feet and legs. Imaging tests may include X-rays or CT scans to see how the bones are aligned. A type of X-ray video called fluoroscopy can show the bones in your child’s legs and feet in motion. A pediatrician may be able to accurately diagnose the cause of your child’s pigeon toes. Or you may need to see a specialist in pediatric orthopedics if the condition appears to be severe.
In cases of mild or even moderate intoeing, children tend to outgrow the problem without any treatment. It can take a few years, but the bones often settle into a proper alignment on their own. Infants with serious metatarsus adductus may need a series of casts placed on their affected foot or feet for weeks. This usually doesn’t happen until a baby is at least six months old. The casts are meant to correct alignment before your child starts walking. Your doctor may show you stretches and massage techniques to help get the baby’s bones growing in the right direction. For tibial torsion or medial femoral torsion, no casts, braces, or special shoes are needed in most cases. The problems simply need time to resolve. There was a time when night braces and a wide range of other devices were recommended for children with pigeon toes. But these were found to be largely ineffective. If by the age of 9 or 10 there has been no real improvement, surgery may be necessary to align the bones properly.
Intoeing usually doesn’t cause any other health complications. Walking and running may be affected, which can interfere with a child’s ability to play sports, dance, or do other activities. In many cases, the presence of pigeon toes doesn’t get in the way. If the condition is somewhat serious, a child may feel self-conscious. There may also be teasing from their peers. As a parent, you should talk with your child about the healing process. Also consider talk therapy with someone trained to work with children facing emotional challenges.
It’s important to keep in mind that pigeon toe doesn’t mean there’s anything permanently wrong with your child’s foot or leg. It’s not a sign that your child’s feet will always turn inward or that they’ll have difficulty walking. It won’t affect their growth or the health of their bones. The vast majority of children who develop intoeing go on to have normal, healthy feet and legs without surgery or any interventions. When surgery is required, it has a high success rate. The outlook for a little one dealing with pigeon toes is almost always positive. For many children, it’s a condition they may outgrow before they form any lasting memories of it.
“When I was a child, my mom decided to take a wait-and-see approach to my intoeing. I never fully grew out of it, but it hasn’t had a negative impact on my life. Turning out my feet during dance lessons was a challenge, but otherwise I was able to fully participate in sports. I was also never embarrassed about my intoeing and instead embraced it as something that made me unique.” – Megan L., 33