Pigeon Toes (In & Out Toed)
Podiatrists, Pigeon Toed Experts in Woodbury Heights, Haddon Heights, Voorhees, & Pine Hill, NJ
Our foot and ankle specialists are experts on all childhood podiatric conditions like pigeon toes.
It is a condition where the feet turn inward at the toes when walking or running. Most commonly seen in children, the condition is usually benign, rectifying before the child reaches their teenage years.
In rare cases, the child's lower extremities and hips can be impacted, leading to bracing or surgery to correct the problem. Some older adults can experience in-toeing due to weakness or even a case of in-toeing that never disappeared during childhood.
What are the causes of pigeon-toed walking?
The cause of in-toeing is differentiated based on the location where the inward turn begins:
Curved foot (metatarsus adductus)
Twisted shin (tibial torsion)
Twisted thigh bone (femoral anteversion)
Metatarsus adductus
It occurs in the long bones of the forefoot. Here, the feet bend inward from the middle part of the foot to the toes. It occurs early in childhood, resolves spontaneously by age 4, and is diagnosed by a clinical exam and X-ray.
Tibial torsion
It is caused by the shinbone (tibia) becoming slightly twisted in some children. This inward turn is usually noticed in 1- to 3-year-olds and is the most common cause of pigeon-toed walking in toddlers.
By age 4 to 5, the condition typically self-resolves. In some cases, tibial torsion can also occur alongside femoral anteversion.
Femoral anteversion
It affects the thigh bone (femur). Where the femoral neck meets the body of the femur, rotation can occur. Femoral anteversion is when the rotation is turned inward, as opposed to femoral retroversion, involving the backward rotation of the femur.
The condition is the most common cause of in-toeing in children aged three and up. Females are affected twice as often as males, and both legs are usually involved. While the condition can worsen by ages 4 to 7, by 8 years old, it should spontaneously resolve.
Risk factors for pigeon feet
Identifying the underlying reason why this condition occurred is difficult. It is believed to develop during pregnancy. Common causes include
Breech position
Low amniotic fluid
Large fetus
Multiple births
Symptoms of in-toeing
Besides an unusual gait, symptoms vary based on the child's age and underlying condition.
Metatarsus adductus can be seen in the pressure sites during shoe wear and the C-shaped lateral border of the foot. Meanwhile, toddlers with tibial torsion may frequently trip over themselves or lose their balance.
Femoral anteversion is perhaps most noticeable, especially in cases related to pigeon feet. Children typically sit with their legs bent and splayed behind them. They cannot sit cross-legged. Frequent tripping and clumsiness are also associated symptoms, alongside a circumduction gait (legs swing around one another).
When to see a podiatrist?
Parents may be tempted to take their child to the doctor the moment they notice a problem. However, the vast majority of children with in-toeing do not need any treatment — the condition will self-resolve.
Nevertheless, we advise bringing your child in so that our expert pediatric podiatrists can assess the situation. Your podiatrists will monitor the condition for improvement. If there is no change in symptoms, the podiatrist may then explore potential treatment options.
Pigeon-toed treatment
In most cases, this condition is diagnosed by clinical examination. Your podiatrist may inspect your child's lower extremities to identify any signs of the underlying cause. A gait analysis can also be performed.
An X-ray can be used to assess the degree of femoral anteversion or tibial torsion.
As stated, almost all cases of in-toeing resolve spontaneously. Depending on the age of presentation, by 3-4 years old, the child's gait should be normal.
Other treatment options for pigeon-toed gait include:
Physical therapy. Exercise to strengthen hip and leg muscles and stretch lower extremity muscles can improve the child's gait.
Casting or bracing. It helps position a child's legs for better movement range during development, enhancing lower limb flexibility.
Surgery. In extreme cases, tibial torsion may require osteotomy surgery. Bone is removed to correct a structural deformity of the shin bone. Surgery is always a last resort, reserved for the most serious and unremitting cases.
Schedule an appointment with our expert pediatric foot doctors at Prime Foot & Ankle Specialists for an initial inspection of pigeon toes.