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Pigeon Toe/In Toe

Pigeon Toe/In Toe

Synonyms and Keywords

False clubfoot, in-toe gait, in-toeing, metatarsus varus.


What is a Pigeon Toe/In Toe?

Look down at your feet. Are they pointing straight or outward? If not and they’re pointing inward, the condition is called metatarsus varus, or pigeon toe and in-toeing in common terms.

Although in-toe gait — walking with inwardly turned feet — is a relatively harmless variation in how the legs and feet line up, it is a very common condition among young children and sometimes even adults. Babies of 8-15 months of age have a natural tendency to turn their legs in when they begin standing, and coupled with the fact that the bony foot structures are mostly soft cartilages (tissue between the joints and bones) at the time, the pressure on their feet can cause the toes to point inward. Fortunately, in-toeing in children is seldom more than a growth and developmental stage and usually corrects itself naturally without medical or surgical treatment, as the child’s foot completes the gradual growing process to reach its final structure.

If a person is pigeon toed, it does not mean something’s wrong with the feet; it just tells of the way the toes point when the person walks. The condition normally does not lead to serious problems nor cause arthritis or clumsiness, even if it never goes away.

Children with in-toeing sometimes have trouble getting shoes that fit, because the curve of their feet, which might make parents consider treatment for their child. Parents may also complain about their child frequently tripping over his or feet and runs in a funny or awkward fashion; such a condition can be evaluated to determine the level (foot, knee, hip) of relevance.

In a rare few children, the condition doesn’t improve on its own and must be treated. The severe cases are considered a form of clubfoot. In some cases, the children have a severe twist in the leg bone (tibia) or thigh bone (femur) that might bother them because it looks ugly — a problem that may be correctable only through surgery.


What Causes a Pigeon Toe/In Toe?

When it’s not due to simple muscle weakness, there are three main theories for pigeon toe. The first starts at the mother’s womb, suggesting that the infant’s legs are usually curled up in the cramp space as it grows, which causes a curvature in the feet as they are pressed into this position inside the uterus.

Second, after a child’s birth, the feet may appear flat but becoming more normal as the baby begins to walk. But if the contorting strain on the hips and legs is severe enough, those feet won’t correct themselves and will produce in-toe gaiting. The resulting twisted shin bone is the most common cause for children under 2 years old (and even with that the knees still point straight ahead). This condition usually improves when the baby starts to stand and walk, though it may take another 6 to 12 months to vanish completely.

Third, pigeon toes in girls over 2 years of age can most often be traced to a hip that turns in, which causes the thigh bone to twist. When the thigh bone twists, the knees and toes point in. This condition usually goes away by itself, but the thigh bone may take 1 to 3 years to straighten.


Who Gets a Pigeon Toe/In Toe?

Pigeon toe is most common in infants and children under two years of age, when the bone structure is still forming and the cartilages are soft enough to be affected by both internal and external pressure. Therefore, it becomes rarer as a body develops with age and corrects the minor flaws naturally. Still, a severe case that was not treated while the person was a child will last into adulthood.


Are There Different Types of a Pigeon Toe/In Toe?

Metatarsus adductus is a common foot deformity noted at birth that causes the front half of the foot (or forefoot) to turn inward — something the parents may notice this while a child is still a baby. In 9 out of 10 children with this problem, the feet straighten as the children grow up.

Internal tibial torsion is a condition in early childhood in which the tibia (leg bone) is twisted inward, causing the child to in-toe as hes/she walks. This is a very common condition and considered normal in babies as well as toddlers taking their first steps. In some children, the twist doesn’t unravel enough to point the feet straight ahead or outward, so these children are still in-toe when they begin walking. Nevertheless, walking often resolves it completely by the time a child reaches 18-24 months in age.

Femoral anteversion is an inward twist in the thigh bone. “Anteversion” literally means “leaning forward,” so this is a condition in which the neck of the thigh bone leans forward with respect to the rest of it, causing the knee and foot on the affected side to turn toward the midline of the body. Because some degree of rotation of the thigh bone is always present as kids grow, this is considered abnormal only when the twist is significantly more inward than an average kid of the same age. In fact, all babies are born with some such inward twist. This type of in-toeing normally appears in children between 2-4 years of age, after they begin walking. It can get worse during early childhood, but frequently the feet will straighten or point outward by the time a child reaches 6-8 years of age.


What are the Symptoms of a Pigeon Toe/In Toe?

The most obvious sign is, of course, the toes pointing inward when walking. It’s more noticeable when a child begins school.

When standing, an in-toed child’s kneecaps can appear to point in or squint toward each other, and the feet can seem asymmetrical (one side worse than the other). This may become more conspicuous at the end of the day when the child is tired.

As well, the child seems awkward when running with feet turning excessively inward, or prone to tripping and falling even on flat surfaces or when no obstacles are present.

Children with a twisted thigh bone often sit with their legs crossed, or otherwise like to sit in a “W” position. The best way to treat this is to have the child sit in a chair with their legs uncrossed, though this often cannot be done until they are school age.

The crease of skin on the inside of the arch, a foot shaped like a “C” when viewed from the sole, and the front half of a foot is turned in relative to the back half of the foot are all symptoms pointing to metatarsus adductus.


How do You Diagnose a Pigeon Toe/In Toe?

Observing the patient when he/she is sitting, standing and walking is important. Seeing the position of the feet, knees, and kneecaps in these situations can give you a basic idea of whether a child has pigeon toe, as well as the possible type and severity of the condition. A thorough clinical examination, and in rare cases with x-rays and CT scans, may be necessary, especially if there is asymmetry of motion between the right and left hip (as it can indicate a misalignment of the hip joint).


How do You Treat a Pigeon Toe/In Toe?

Treatment for pigeon-toed feet is almost never required, since most of the conditions are self-correcting during childhood. Time is typically the sole remedy needed, though it may take several years before an in-toed foot is straight. Only in the very few cases when it doesn’t get better on its own that you should seek treatment.


Self-Care at Home

If your child walks with his/her feet turned in, there are simple measures you can take to stop the condition from getting worse, such as positioning the child’s feet when he/she is sleeping so they are pointing outward, and encouraging the child to sit Indian style rather than on his/her knees or feet and forming a W in that position. Keeping the child from crossing his/her legs will help, too.

For very mild pigeon toes, you can ask a podiatrist to show you how to rub the outside of the foot to help straighten it. Some children may need to wear special shoes and braces, which is usually done before they reach 12 months of age.

If a pigeon toe is spotted early enough, non-clinical treatments include stretching exercises and even special bars to align the feet and lower legs. Ballet has been used to correct mild cases, and dance exercises can help to bend the legs outward.

Regardless, it is important to remember that many “in-toe” deformities correct themselves, often by a child’s eighth birthday. Knowing this will help you explain it to the child who may be depressed, frustrated, or even angry because of the way his/her feet look and the “funny” way he/she walks. The condition is very common and, chances are, the child will “grow” out of it soon enough. However, if you are concerned about a persistent condition or in-toe gait pattern, consult your podiatrist at the earliest opportunity.


Professional Treatments

For most cases, advice on how to adjust and improve the child’s knee and foot development from a podiatrist many be all that is necessary.

If the foot is rigid and cannot be straightened, the condition may necessitate putting casts on the feet and lower legs. A child who is tripping and falling or has an excessively turned-in posture will also benefit from a cast that goes above the knee for 2-6 weeks, followed by night splinting after the cast’s removal to maintain the correction.

The podiatrist may prescribe orthotics and braces to help move the foot toward external rotation when walking.


Surgical Treatments

Surgery is rarely performed, unless the deformity is excessive enough to cause constant tripping and fall and there is a genuine concern over appearance. In a small number of children, the inward twist in the thigh bone is severe and doesn’t go away, so a surgery may be necessary to cut the bones and turn (rotate) them outward to point the feet straight. The procedure is usually considered only when the children are at least 10 years or older.


How to Prevent a Pigeon Toe/In Toe?

Because a pigeon toe is something you are born with, you really cannot prevent the problem from occurring. However, applying the proper home or professional care will speed up the corrective process.


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