Seeing a child's toes point inward may cause a parent concern. However, this common and painless condition, known as pigeon toe or pediatric intoeing, occurs very often in children under the age of 2. It can happen in one or both feet. The condition usually corrects itself with no intervention.
Pigeon toe often develops in the womb or is due to genetic birth defects, so little can be done to prevent it. Contrary to popular belief, there are no known shoes that help prevent pigeon toe and no evidence to suggest that learning to walk in bare feet has any effect on the condition.
Contents of this article:
Causes of pigeon toe
Pigeon toe may develop in the womb and often corrects itself.
There are three potential causes of pigeon toe:
Metatarsus varus or metatarsus adductus
In this condition, the foot has a curved, half-moon appearance. The front of the foot is angled in toward the middle of the foot, while the back of the foot and ankle are normal. This type of pigeon toe normally stems from the position the child was in while in the womb.
This type of pigeon toe is fairly common in babies who were breech in utero or whose mothers had less amniotic fluid. In some cases, there may be a family history of the condition.
A doctor is normally able to straighten the foot out once the child is born, and as the child gets older, no further treatment should be required. If desired, a parent can also gently stretch the baby's feet a few times a day to help correct the shape, though this is not necessary.
Internal tibial torsion
Internal tibial torsion is caused by an inward twisting of the lower leg bone, or the tibia. Initially not noticeable, it often appears about the same time as a child first starts walking.
Children with internal tibial torsion do not usually feel any pain, but parents often report that their child falls frequently. As the child gets older, this type of pigeon toe almost always corrects itself and the child does not normally require any therapy, bracing, or casting.
In more severe cases, and if it does not resolve by the time a child reaches 9 or 10 years of age, internal tibial torsion may require surgery to fix it. The procedure involves cutting through the twisted bone and reattaching it to make the foot straighter.
This type of pigeon toe is very common. It affects up 10 percent of children. The upper leg bone, known as the femur, is overly rotated inward in the hip joint. This is due to likely to be caused by stress to the hips before birth.
This type of intoeing normally clears by the age of 8 years. If it continues after this age, an orthopedic surgeon should be consulted to determine if the child needs corrective surgery.
In some cases, children with weaker hip bones may develop pigeon toe. This is more common in girls. Children with weaker muscles and tendons may also develop pigeon toe. However, as a child's leg and hip muscles naturally get stronger over time, both of these types of pigeon toe tend to disappear.
What is pigeon toe like for different age groups?
In pigeon-toed children, the foot and toes often look as if they are pointed inward, but it can look different in children of various ages.
Pigeon toeing may appear as follows:
- Infants: The front of the foot and toes often bend in towards the middle of the foot. The outer part of the baby's feet will often have a half-moon shape. Mostly, this occurs in both feet.
- Toddlers aged from 1 to 3 years: The pigeon toeing most commonly seen in toddlers is normally the result of tibial torsion where the shinbone is rotated inward. A child in this age group that has pigeon toeing may appear bowlegged.
- Children between 3 and 10 years: Femoral anteversion is the most frequent cause of pigeon toeing in this age group. Children with this often prefer to sit in a "w" position, where their knees appear to go inward.
Pigeon toe presents slightly differently as children start to walk. Very often, the cause is due to the leg, not the foot, and the child's toes appear to point towards each other.
When to see a doctor
There is normally no need to see a doctor right away. However, if pigeon toe is still apparent by the time a child reaches 8 years, or if it causes the child to fall more often than normal, a doctor should be consulted. Most parents seek medical advice regarding pigeon toe as part of their child's routine exams.
Diagnosis for pigeon toe depends on the type of pigeon toe a child has. To diagnose the condition, a simple physical exam may be needed. In some cases, X-rays and other imaging may be necessary.
For metatarsus varus or metatarsus adductus, diagnosis could be very early, possibly during the newborn's post-birth examination. A simple physical examination will be sufficient. The doctor should also rule out issues with the hip that may be the cause.
Internal tibial torsion does not usually appear until the child starts to walk, so the earliest diagnosis may be slightly before 1 year of age. Diagnosis most commonly happens during a physical examination of the infant's legs. If diagnosed, the doctor will take measurements of the legs.
Femoral anteversion is most often diagnosed when the child is between the ages of 4-6 years. This will normally start with a physical examination and a review of the medical history of the child and family.
Treating pigeon toe
Surgery may be needed to correct bones but this might be used when other options have been exhausted.
It is easy to treat most cases of pigeon toe. The most common treatments are time, normal growth, and reassurance. Normally, little or no further intervention is necessary.
If more medical intervention is needed, treatment may include:
- Braces for the legs that slowly correct the position of the bones or feet
- Molds that correct the shape of the foot
- Surgery to correct the positioning of the bones that cause pigeon toe
A doctor or therapist may recommend additional therapies that focus attention on parts of the legs and hips if weakness in those areas may have some impact on the pigeon toe.
Because most cases of pigeon toe resolve on their own over time, most doctors do not recommend much intervention early on. Mostly, they will recommend monitoring and observation.
Are children with pigeon toe able to exercise
Children with pigeon toe can exercise normally and the condition rarely causes any pain. The most common issue is that children with in-turned bones may trip more regularly than other children when exercising. In most cases, simple walking, running, and other natural activities that children do are the best daily exercises.