Parents can get concerned when they see their child in-toeing (pigeon-toed). In-toeing means that when a child walks or runs, the feet turn inward instead of pointing straight ahead. It is commonly referred to as being “pigeon-toed”. In-toeing is often first noticed by parents when a baby begins walking.

When babies start walking, they have a different way of walking, and they gradually adopt to the “adult” way of walking in about two years. A lot of the issues that cause the appearance will resolve in the next few years. In-toeing can resolve itself, but there are no guarantees. Thus, we need to watch each case. If it is still visible after 15 months of age, treatment should begin.

There are 3 different causes for this, and they are:

  • Metatarsus adductus
  • Tibial torsion
  • Femoral anteversion

Metatarsus adductus (the foot turns inward)

Babies aged six to nine months with severe deformity or feet that are very rigid may be treated with casts or special shoes with a high rate of success.

Tibial torsion (the shinbone turns inward)

Tibial torsion occurs if the child’s lower leg (tibia) twists inward. This can occur before birth, as the legs rotate to fit in the confined space of the womb. After birth, an infant’s legs should gradually rotate to align properly. If the lower leg remains turned in, the result is tibial torsion.

When the child begins walking, the feet turn inward because the tibia in the lower leg, just above the foot, points the foot inward. As the child grows taller, the tibia usually untwists.

Tibial torsion almost always improves without treatment, and usually before school age. Splints, special shoes, and exercise programs do not help. Surgery to reset the bone may be done in a child who is at least eight to 10 years old and has a severe twist that causes significant walking problems.

Femoral anteversion (the thighbone turns inward)

Femoral anteversion (also known as excessive femoral torsion) occurs when a child’s thighbone (femur) turns inward. It is often most obvious at about five or six years of age.

Femoral anteversion spontaneously corrects in almost all children as they grow older. Studies have found that special shoes, braces, and exercises do not help. Surgery is usually not considered unless the child is older than nine or 10 years and has a severe deformity that causes tripping and an unsightly gait. When indicated, surgery for femoral anteversion involves cutting the femur and rotating it into proper alignment.

There is normally no need to treat it immediately. However, if pigeon toe is still apparent by the time a child reaches five years, or if it causes the child to fall more often than normal or cause pain or a limp, they should be seen.

Children who have Cerebral Palsy or other neurological conditions and in-toe may need surgery because the processes that are mentioned here do not happen in the same way with these children.

See a Pedorthist who is able to assess the one in-toeing. The Pedorthist is one that is able to help assess and treat in-toeing if it is required. The treatments can start with foot orthotics and with exercises. Orthoses (foot orthotics) can reduce tripping, reduce in-toeing and prevent problems in the feet as a result of this.

There are a series of exercises that can be given to strengthen hip and thigh muscles and to encourage hip outward rotation. Having the child avoid sitting with the legs bent to make W-sitting position.

If you have questions about any part of this, please talk to your local pedorthist to help keep your child active and progressing in a healthy way.


Written by Jim Pattison, Certified Canadian Pedorthist