Seeing a child's toes point inward may cause concern for a parent. However, this common and painless condition, known as pigeon toe or pediatric intoeing, is common in children up to the age of 8 years.

It can happen in one or both feet. The condition usually corrects itself without treatment.

Pigeon toe often develops in the womb or due to genetic anomalies, so a person can do very little to prevent it.

No evidence exists to support any type of shoe that claims to help prevent or, in most cases, treat pigeon toe or that learning to walk in bare feet can help redirect pigeon toes.

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Pigeon toe is common and easy to treat.

It is easy to treat most cases of pigeon toe.

The most common treatments are time, allowing a child to grow normally, and reassurance. Normally, little or no further intervention is necessary.

In the rare case that the feet require further medical intervention, practitioners will often suggest one of the following:

  • molds or casts that correct the foot shape
  • surgery to correct the positioning of the bones that cause pigeon toe

A doctor or therapist may recommend additional therapies that focus on parts of the legs and hips. If they feel any weakness in those areas, it may be linked to the pigeon toe.

As most cases of pigeon toe resolve on their own over time, most doctors do not recommend much intervention in the early stages. They mostly recommend that monitoring and observation are effective first steps.

Are children with pigeon toe able to exercise

Children with pigeon toe can exercise normally, and the condition rarely causes pain.

The most common issue is that children with in-turned feet may trip more regularly than other children during exercise. This tendency usually resolves before treatment has fully corrected the toes.

In most cases, simple walking, running, and other activities that occur naturally in children are the best daily exercises.

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, while the back of the foot and ankle are normal. This type of pigeon toe normally results from the position the child took in the womb.

Metatarsus varus is fairly common in babies who were breech in utero, meaning that they were facing the wrong way in the womb. It also occurs more often in children whose mothers had low levels of amniotic fluid. For some people with the condition, there may be a family history.

This condition is usually "flexible" and the foot can be easily straightened. This resolves as the child gets older, and no further treatment should be required. If the foot position is "fixed" and does not improve, further treatment is occasionally necessary.

If desired, a parent can also gently stretch the feet of the infant 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 legbone, or the tibia. It is initially not noticeable but often becomes apparent at about the same time as a child's first steps.

Children with internal tibial torsion do not usually feel any pain, but parents often report that their child experiences frequent falls.

As the child grows older, this type of pigeon toe almost always corrects itself without treatment, and the child does not normally require any therapy, bracing, or casting.

If it does not resolve by the time a child reaches 9 or 10 years of age, internal tibial torsion may require surgery. The procedure involves cutting through and reattaching the twisted bone to straighten the foot.

Femoral anteversion

This type of pigeon toe is very common and occurs in 10 percent of children.

The upper leg bone, known as the femur, experiences too much rotation inward at the hip joint. This is likely due to stress on the hips before birth, though the true cause is unknown.

This type of intoeing normally clears by the age of 8 years. If symptoms continue after this age, consult an orthopedic surgeon to determine whether the child needs corrective surgery.

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Intoeing can be observable from birth. However, there is often very little to worry about.

In children with pigeon toe, the feet and toes often can appear 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. This frequently occurs in both feet.

Toddlers aged from 1 to 3 years: A child in this age group that has pigeon toeing may appear bowlegged. The pigeon toeing most commonly seen in toddlers is normally the result of tibial torsion, in which the shinbone rotates inward.

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. There is no harm in allowing your child to sit in this position if they prefer it.

Pigeon toe presents slightly differently as children start to walk and as they get older. 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 immediately. 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, consult a healthcare professional. Most parents seek medical advice regarding pigeon toe as part of their child's routine exams.

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The doctor will sometimes but not always take an x-ray of the feet to diagnose pigeon toe.

A diagnosis of pigeon toe depends on the type.

To diagnose the condition, the doctor carries out a simple physical exam. In some cases, X-rays, and other imaging may be necessary, but this is uncommon.

For metatarsus varus or metatarsus adductus, diagnosis can take place very early, sometimes during the post-birth examination. A simple physical examination should be enough. The doctor should also rule out issues with the hip that may be causing the intoeing.

Internal tibial torsion does not usually occur until the child starts to walk, so the earliest diagnosis may happen just before 1 year of age. A doctor will diagnose this by watching a child walk and by examining the child's legs. If the doctor reaches a diagnosis, they may measure the legs.

A doctor most often diagnoses femoral anteversion between the ages of 4 and 6 years. This will normally start with a physical examination and review the medical history of the child and family.

Whatever the diagnosis, pigeon toe should give no great cause for concern as it is painless and often resolves without treatment.

Pigeon toe is a harmless, painless, and common orthopedic condition that occurs in young children.

The toes point inward instead of straight ahead. There are three different causes of pigeon toe, and the type dictates the level of treatment necessary to correct the problem.

However, a child would be able to exercise and live a full, happy life without impaired movement or uneven gait.

Q:

Will pigeon toe affect my child later in life?

A:

Virtually all children outgrow being pigeon-toed by the time they are teenagers. Once it is outgrown, having been pigeon-toed as a child does not affect how a person walks, runs, or plays sports as an adult.

For people who remain mildly pigeon-toed into adulthood, it generally does not interfere with their ability to participate in activities. In fact, you can find many examples of professional athletes who are pigeon-toed.

Karen Gill, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.