What is Intoeing (Pigeon Toes) in Children?

Intoeing is a common childhood condition that concerns parents — even if they shouldn’t worry most of the time. In intoeing, a child’s toes point inward instead of forward, possibly involving one or both feet. There are a variety of reasons for this condition, depending on the age of the child. They include:

Metatarsus Adductus — 1 to 2 out of every 1,000 infants are born with one or both feet turned inward. Typically, intoeing in the first year of life is due to a condition known as metatarsus adductus, where the front part of the foot turns in when the foot is at rest. This causes the outer part of the foot to curve inward, as well, in the shape of the letter “C”. Metatarsus adductus is likely due to the baby being crowded while still in the uterus, resulting in an abnormal positioning of one or both feet. Thankfully, most babies’ feet will straighten out on their own by a year of age without any intervention. Some doctors will also recommend gentle stretching exercises. Rarely, babies will need casting or surgery to correct the problem.

Tibial Torsion — When a toddler begins to walk, the most common cause of intoeing is tibial torsion.  Parents may become concerned if they notice their child walking with the kneecap pointed forward, but the feet pointed inward. Tibial torsion occurs when the larger bone in the lower leg, the tibia, rotates. As the toddler grows, the in-turned tibias usually straighten out on their own. Most children outgrow this condition by the time they are of school age. If a child’s tibial torsion does not correct on its own by the ages of 8 to 10, or if the rotation is severe enough to cause difficulty walking, surgery may be indicated at that time.

Femoral Anteversion — In older children, the femur may be twisted inward, causing the child to be pigeon-toed. This condition, thought to be due tight hip muscles caused by in utero positioning, is known as femoral anteversion. This condition is most commonly detected in children around the ages of 4 to 6. In femoral anteversion, both the kneecaps and the feet are pointed inward.  In most children, this improves on its own with time, so that many children with this condition walk normally by 8 to 10 years old. It is not associated with any joint or bone problems later in life.

It is important for parents to remember that most causes of intoeing will resolve over time with no invasive interventions. The cause is usually apparent in a physical exam by an experienced pediatrician. X-rays are rarely needed to determine the cause of intoeing, and surgery is only indicated in severe deformities that do not correct on their own.

Sources:

• American Academy of Pediatrics
• Pigeon Toes in Children.
  Pediatric Care Online
• Intoeing and Outtoeing.
  Pediatrics in Review
• Lower Extremity Disorders in Children.

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