Pigeon Toes (Intoeing)

Overview

What are pigeon toes?

With pigeon toes, your child’s toes point toward each other instead of forward. Pigeon toes are commonly caused by bones or joints that don’t point the right way (misaligned). Also called intoeing, pigeon toes may be noted as your child begins walking.

It’s normal for parents to worry about their children, especially when they are babies and can’t tell you if something hurts. But pigeon toes don’t cause pain. In most cases, pigeon toes resolve on their own without causing long-term issues.

How common are pigeon toes?

Pigeon toes are common in the first few years of life. As the condition usually gets better as children learn to walk, pigeon toes are less common as children reach adolescence. Infrequently, pigeon toes may last into adulthood.

How do pigeon toes affect my child’s body?

Your child’s feet may turn in at rest and/or when walking. Although this might look different to you, pigeon toes are quite common. Pigeon toes generally do not cause pain, and the condition should go away on its own as your child grows.

Symptoms and Causes

What causes pigeon toes?

When bones in the foot, shin or thigh aren’t aligned, your child’s healthcare provider may use the term “pigeon toes” or intoeing. There are three common causes of pigeon toes:

  • Bones in the foot. The bones that connect your toes to your ankle are called metatarsals. Metatarsus adductus is a malformation in the midfoot that is present at birth (congenital). The toes point toward the center, giving the foot a “C” shape. This is a common cause of pigeon toes in babies younger than 12 months of age. Certain things may make your child more likely to have metatarsus adductus, including if your fetus was breech, if there was not enough amniotic fluid (oligohydramnios) and family history.
  • The shin bone (tibia). The most common cause of pigeon toes that develop between the ages of 1 and 3 is when the shin bone or tibia is turned inward (inward tibial torsion), toward the middle of the body. If your child’s tibia is inwardly rotated, they may appear bow-legged. This condition usually resolves on its own by the time your child is 5 years old.
  • The thigh bone (femur). When your knee looks turned inward in relation to your hip, it’s called femoral anteversion. It’s caused by an inward rotation of your thigh bone (femur). This condition can be passed on from parents to children. Femoral anteversion can also be the result of the position of your fetus — or crowding — in your uterus. Femoral anteversion is usually diagnosed between the ages of 3 and 6, and then it gradually decreases.

Rarely, other problems can be associated with pigeon toes. These include:

What causes pigeon toes in adults?

Although pigeon toes usually go away on their own as you get older, certain conditions may cause pigeon toes that last into adulthood:

  • Metatarsus adductus, when your toes point toward inward, giving your foot a “C” shape.
  • Femoral anteversion, when your thigh bone rotates inward from your hip.

What are the symptoms of pigeon toes?

With pigeon toes, your feet point toward each other while:

  • At rest.
  • Standing.
  • Walking.
  • Running.

Children with pigeon toes may trip and fall more than their peers when they move quickly. Although pigeon toes don’t cause arthritis directly, you’re at higher risk for stress fractures and arthritis if the condition lasts into adulthood.

Diagnosis and Tests

How are pigeon toes diagnosed?

Pigeon toes are often diagnosed by healthcare providers during routine well-child check-ups. They’ll conduct a physical exam and ask about your child’s medical history. If your child has started walking, your healthcare provider will observe them, looking carefully at the angles of their feet, ankle, knees and hips. Healthcare providers might also watch older children run.

What tests will be done to diagnose pigeon toes?

Your healthcare provider diagnoses pigeon toes using angle and flexibility tests. These tests are a part of a physical exam. X-rays aren’t usually necessary unless your child has symptoms that don’t go away as they age.

Management and Treatment

How are pigeon toes treated?

Most cases of pigeon toes get better on their own. Depending on the cause of pigeon toes, your healthcare provider may just watch and wait. Or they might recommend exercises or physical therapy to fix pigeon toes. Very rarely, other treatments may be considered, including:

  • Serial casting: If the metatarsus adductus is severe or doesn’t improve on its own, your child’s healthcare provider may suggest a series of casts to stretch and lengthen their muscles. As you might imagine, it’s very important to keep your baby’s casts clean and dry. But it’s no small task. The casts may also cause itching and foul odors. Call your child’s healthcare provider to discuss any questions about serial casting.
  • Surgery (osteotomy): If severe tibia-related pigeon toes are causing functional problems as your child approaches adolescence, your healthcare provider may refer you to a pediatric orthopaedic surgeon to discuss the possibility of surgery. Surgery isn’t generally recommended for femoral anteversion, but may be considered for children older than 11 with severe symptoms.

Prevention

Can pigeon toes be prevented?

When it comes to prevention, we look at the risk factors related to a disease in terms of things you can change and things you can’t change. The causes of pigeon toes aren’t something you can do anything about. They include:

The good news is that pigeon toes rarely cause pain and tend to get better on their own.

Outlook / Prognosis

What is the outlook for people with pigeon toes?

The outlook for children with pigeon toes is good. Pigeon toes usually improve as children grow and their coordination improves. If the condition lasts into their school years, they may feel self-conscious. In rare cases, your healthcare provider may discuss the risks and benefits of treatment with serial casts or surgery.

Living With

When should I see my healthcare provider for pigeon toes?

Talk with your pediatrician if you have concerns about:

  • The appearance of your child’s feet or legs, especially if you think their legs curve outward (bow-legged).
  • If they seem to fall a lot.
  • If they don’t look normal to you when they run.

What questions should I ask my doctor?

  • What is the cause of my child’s pigeon toes?
  • Will pigeon toes go away without treatment?
  • Are there any exercises we can do to help correct pigeon toes?

Frequently Asked Questions

Can you fix pigeon toes?

Pigeon toes rarely last into adulthood. Generally, pigeon toes go away on their own without treatment as children grow and develop muscle strength and coordination. Your child’s healthcare provider will keep an eye on their pigeon toes. Very rarely, serial casting or surgery may be discussed as options to fix pigeon toes.

Is being pigeon toed a disability?

Although you may not like the way pigeon toes look, being pigeon toed isn’t a disability. People with pigeon toes can walk, run and perform daily tasks of living.

Can you fix pigeon toe in adults?

Pigeon toes rarely need to be fixed, even in adults. If you have concerns about the way you walk (your gait), discuss them with your healthcare provider. They may recommend exercises or physical therapy that can make pigeon toes less noticeable.

Is pigeon toe a birth defect?

A birth defect is something abnormal in your newborn’s body. Pigeon toes are common in many babies and toddlers and aren’t considered a birth defect.

A note from Cleveland Clinic

Pigeon toes can be a source of anxiety for parents. But rest assured, pigeon toes don’t cause pain. And although you may worry about how your child looks when walking, pigeon toes usually go away on their own without treatment and won’t cause permanent damage. If you have concerns about the appearance of your child’s legs or feet, discuss them with your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 09/21/2021.

References

  • American Academy of Pediatrics. Pigeon toe (in-toeing). (https://www.healthychildren.org/English/health-issues/conditions/orthopedic/Pages/Pigeon-Toes-Intoeing.aspx) Accessed 9/21/2021.
  • American Academy of Orthopaedic Surgeons. Intoeing. (https://orthoinfo.aaos.org/en/diseases--conditions/intoeing/) Accessed 9/21/2021.
  • Blackmur JP, Murray AW. Do children who intoe need to be referred to an orthopaedic clinic? (https://pubmed.ncbi.nlm.nih.gov/20520580/) J. Pediatr Orthop B. 2010 Sep;19(5):415-7. Accessed 9/21/2021.
  • Bosch P, Rab GT. Pediatric Orthopedic Surgery. In: McMahon PJ, Skinner HB. eds. Current Diagnosis & Treatment in Orthopedics, Sixth Edition. McGraw Hill. Accessed 9/21/2021.
  • Faulks S, Brown K, Birch JG. Spectrum of Diagnosis and Disposition of Patients Referred to a Pediatric Orthopaedic Center for Intoeing. (https://pubmed.ncbi.nlm.nih.gov/28471818/) J Pediatr Orthop. 2017;37(7):e432-e435. Accessed 9/21/2021.
  • Sielatycki JA, Hennrikus WL, Swenson RD, Fanelli MG, Reighard CJ, Hamp JA. Intoeing Is Often a Primary Care Orthopaedic Condition. (https://pubmed.ncbi.nlm.nih.gov/27470689/) J Pediatr. 2016 Oct;117:297-301. Accessed 9/21/2021.
  • U.S. National Library of Medicine. Metatarsus Adductus. (https://medlineplus.gov/ency/article/001601.htm) Accessed 9/21/2021.

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