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In-toeing (Intoeing, Pigeon Toed)

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What is it?

Intoeing in children is a normal stage of walking as a toddler. Most children will grow out of intoeing. However, if after the age of 6 or 7 they are still intoeing it may be due to a structural cause. There are 3 causes:

1) The bones of the foot can be angled inwards – metatarsus adductus

2) The tibia (shin bones) are slightly twisted inwards – tibial torsion

3) The femur (thigh bone) is twisted inwards – femoral anteversion

Intoeing is often called pigeon toe.

What do we need to do?

The best thing to do is watch and wait. As a parent, you know your child best so if you are concerned do access help.

You could encourage your children to perform activities that make them out toe, for example ballet or side footing a football.

Even though in-toeing may not correct completely with age, usually children remain pain free and functionally have no issues.

When to see a Podiatrist?

Intoeing can be totally normal in children of a young age. However, we recommend that you see a Podiatrist if you are concerned that they aren’t “growing out” of their intoeing or if it is a severe case.

It is also good to get them assessed if their intoeing is only in one leg or causing tripping, pain or an inability to keep up with other children of a similar age.

A Podiatrist will take a thorough history (including birth history and developmental milestones) and discuss the history of pain or limping. The physical exam might include watching your child walk and run, and checking range of motion of the hips, knees, ankles, and feet. They may also check muscle tightness, nerve / muscle function, and coordination.

If they are concerned they may order x-rays or refer your child to an orthopaedic/paediatric specialist.

Treatment is dependent on the underlying diagnosis that is causing the in-toeing. Normal “developmental” in-toeing can be reviewed periodically.

Occasionally, internal tibial torsion or femoral anteversion may require surgery but this is very rare.