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Intoeing (Pigeon Toes)
Most people's feet point straight ahead or outward. In some people, however, the feet point inward. This is called intoeing or "pigeon toes”. Intoeing is very common in young children, with most children under the age of two years having some degree of intoeing as part of normal development. Most of the time, intoeing goes away without any treatment. In a few children, it doesn't get better on its own and may need to be treated.
Intoeing may cause the child to stumble and trip but it does not cause pain and does not lead to other conditions such as arthritis. There may be difficulty with getting shoes to correctly fit, and some children may be concerned about looking different.
Intoeing has a tendency to run in families.
Causes
There are three main causes of intoeing.
Congenital Metatarsus Adductus
This is thought to result from the curled-up position of the baby before birth. The child’s feet may curve in from the middle of one or both feet and may be shaped like kidney beans. This condition tends to correct itself within the first few years of life.
Femoral Torsion
The femur (thigh bone) is the bone that runs from the hip to the knee. In femoral torsion (also called excess femoral anteversion), the femur is rotated inwards, causing the knees and feet to point inwards. This is a common finding in babies and the condition usually resolves by the age of 10 years. It is often first noticed between the ages of two and four years. Children with femoral torsion may have difficulty sitting in a cross-legged position and tend to sit on their knees with their feet flared out behind them.
Tibial Torsion
The tibia (shin bone) is the bone at the front of the leg that runs from the knee to the ankle. In tibial torsion, the tibia is rotated inwards, causing the feet to point inwards. Again, this is a common finding in babies, and the tibia normally straightens by the age of 18 to 24 months. If tibial torsion does not resolve, it is usually first noticed when the child starts walking.
Treatment
Most causes of intoeing correct themselves in early childhood and do not require treatment. Treatment may be required, however, if the degree of intoeing is severe and/or it does not resolve over time.
In cases of severe congenital metatarsal adductus, casting or splinting of the feet may be recommended. The cast/splint stretches the feet into a straight position. It is recommended that this treatment is completed before the child is of walking age.
There may be some residual curve in the feet after treatment, however this will not affect activity and does not cause any discomfort.
Tibial and femoral torsion nearly always resolve without treatment. However in cases of severe tibial or femoral torsion that cause difficulties with walking, surgery may be recommended. Surgery involves cutting the femur or tibia and repositioning it outward, so the toes point straight ahead. Surgery is not usually considered until after the age of eight years as the leg bones continue to grow straighter until around that age.
References
AmericanAcademy of Orthopaedic Surgeons (2007) Intoeing. AmericanAcademy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00055
Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
Mancini, L. (2006) Intoeing (pigeon toe). Clinical Reference Systems. In Health and WellnessResourceCenter. McKesson Health Solutions.
Last Reviewed – 19/12/07