Pigeon Toes (Intoeing)

Pigeon toes are when your child’s toes point in toward each other instead of forward when they stand or walk. Intoeing is the medical name for it.

You might first notice that your child has pigeon toes when they start walking. It’s a very common type of gait disorder. That’s any condition that affects the way you walk or move your legs.

The good news is that intoeing is usually a temporary issue. Most children grow out of it naturally as their legs develop.

Visit a healthcare provider if you notice your child walking or standing with their toes turned in. It’s almost always harmless. But your provider will check your child’s feet and legs for any issues that need treatment.

Symptoms of intoeing

The way your child’s feet turn inward is the most obvious symptom. Their toes will angle in, toward each other instead of pointing straight ahead.

Children with pigeon toes may trip and fall more often, especially when they’re running. Intoeing can affect their balance.

Your child might wear out their shoes in an uneven way or sooner than you’d expect. Having pigeon toes can make them put more pressure on some parts of their feet than usual.

Causes of pigeon toes

Most of the time, intoeing happens because of natural variations in your child’s bones. If the bones in their feet or legs aren’t aligned, their toes may turn in.

There are three main causes:

• Internal tibial torsion: This is when your child’s shin bones twist or rotate toward the center of their body instead of being straight like they should.
• Femoral anteversion: This is similar to internal torsion, but at the top of your child’s thigh bone instead. Their thigh bones will point forward more than they should. This makes their legs rotate in. It’s often associated with W sitting.
• Metatarsus adductus: This is when bones in your child’s feet curve inward from the middle of their foot. This can give their foot a “C” shape.

It’s much less common, but some other conditions can cause pigeon toes, including:

• Cerebral palsy
• Clubfoot
• Skew foot
• Hip dysplasia

How doctors diagnose this condition

A healthcare provider can probably diagnose pigeon toes with a simple physical exam. They’ll look at your child’s legs and feet. Your provider will watch them stand and move.

Your provider may check your child’s flexibility or put their legs in specific positions. This can help identify specific causes. Your child probably won’t need X-rays or other imaging tests.

How is it treated?

Your child probably won’t need any treatment for pigeon toes. It usually goes away on its own as your child grows and develops. Children’s bones change and reshape themselves quickly. This usually corrects pigeon toes.

Your provider may suggest physical therapy or exercises to strengthen muscles in your child’s legs and feet. They’ll monitor any changes at your child’s future checkups.

Needing other treatment is rare. Your child will usually only need it if they still have symptoms past age nine or 10, or if intoeing makes it hard for them to move. In these rare cases, your child might need:

• Special shoes or braces: Your child may need to wear shoe inserts or customized shoes. These will keep their feet in the proper alignment. They may also need braces. Braces gently push their legs in the right direction to counteract any torsion.
• Casts: Your provider will put your child’s legs in a series of casts. Over time, the casts will stretch and lengthen their muscles. This will help keep your child’s legs in the correct positions.
• Surgery: It’s extremely rare to need surgery for intoeing. Your provider will usually only suggest it if your child has severe tibial torsion that doesn’t get better on its own.

When should I see my healthcare provider?

Visit a healthcare provider as soon as you notice any signs of pigeon toes in your child. Even if they won’t need treatment, it’s important to get intoeing diagnosed. That way, you can keep an eye on it as your child develops.

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.