What Does It Mean to Be Pigeon Toed?

Medically reviewed by Danielle McNeil, D.P.M

If your baby's feet tend to point toward one another—known as pigeon toe—you may be wondering how this will impact them when they begin to walk. While it's not uncommon for parents to worry about this alignment, pigeon toes are actually quite common in young children and usually nothing to be concerned about.

Many young children have intoeing—as it is formally called—due to the limited space they have in the womb while they develop. This cramped environment can cause their feet and legs to rotate toward one another. In fact, metatarsus adductus, the most common cause of intoeing, occurs in 1 in 1000 births.

While most intoeing occurs at birth, it also can become more apparent when your child starts to toddle around. But, in most cases, intoeing will improve as your child grows. Most pediatricians tend to take a wait and see approach. X-rays and other tests are usually not needed.

Keep reading for the causes of intoeing, how it is diagnosed, and what treatment options are available. You will even find information on the complications associated with pigeon toes and when to see a healthcare provider.

What Causes Pigeon Toes?

Intoeing, which is one of the most common musculoskeletal findings in pediatric patients, can be largely attributed to normal variations in development. In fact, one study of more than 925 children found that approximately 95% of the kids evaluated had a benign diagnosis that did not require any treatment.

That said, there is a small percentage of kids for whom intoeing is a sign of an underlying condition like cerebral palsy, club foot, or developmental dysplasia of the hip. In these situations, they will need to be evaluated and treated by an orthopedic specialist.

Some researchers theorize that when your baby's legs begin developing in the womb, their lower limbs can rotate bringing their big toe toward midline. This positioning then causes limb rotational deformities and eventually leads to intoeing after they are born.

Three of the most common types of intoeing include metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Typically, these conditions can be diagnosed by a pediatrician without the use of X-rays, CT scans, or other radiographical exams. Here is what you need to know about each type of intoeing and the causes behind each.

Metatarsus Adductus

Metatarsus adductus is a common foot deformity that causes the front half of the foot to turn inward. Typically, metatarsus adductus is apparent when your baby is born or during infancy. Healthcare providers speculate that it could be caused by the way your baby's feet were positioned inside the uterus before they are born.

In mild cases—when there is good range of motion—your baby will likely show improvement by 12 months. By the time they reach their third birthday, the condition should have resolved. However, treatment should not be delayed that long if you're child is having trouble walking—intervention should begin as soon as possible.

Internal Tibia Torsion

Once your child begins walking—or around 1 to 2 years of age—you may notice internal tibia torsion. This type of intoeing is most likely due to inward twisting of the shinbone or the tibia.

Internal tibia torsion is usually mild and improves by the time your child reaches 4 to 6 years old. While the exact cause of this type of leg positioning is not know, researchers theorize that it also is caused by intrauterine positioning.

Increased Femoral Anteversion

Increased femoral anteversion usually becomes apparent after your child's second birthday and resolves by the time they are 10 to 12 years old. The exact cause for this type of intoeing is not known, but researchers theorize that it could be related to abnormal sitting positions, such as sitting with their legs in a "W" position, or sleeping in a prone position. It also could be connected to persistent infantile anteversion.

Signs and Symptoms

The most notable sign of intoeing occurs when your child's toes turn inward rather than forward when your child is standing, walking, or running. If your child is an infant, you may notice that their feet have a "C" shape or look like crescent moons while another sign of intoeing are thighs or shins that turn inward.

In cases where there is an underlying condition, such as cerebral palsy, hip dysplasia, or clubfeet causing the intoeing, you may notice additional symptoms. For instance, with hip dysplasia, your baby may have instability in their hip and limited mobility, or they might experience pain, limping, or a popping sound.

If your baby is not walking yet or able to express pain, look for asymmetry in their thigh folds while your baby is laying on their stomach, or asymmetric knee height when laying flat with their knees bent and soles of the feet on a surface.

Can Pigeon Toes Cause Complications?

Most of the time, intoeing does not cause any problems. Your child's feet will gradually straighten out as they grow and develop. But, if the condition continues or is caused by an underlying issue, it needs to be addressed or they may experience complications.

Left untreated, intoeing that is caused by an underlying condition can lead to an unbalanced way of walking that can cause strain—and sometimes even pain. Your child also may have limited athletic ability including issues with running and jumping. Some kids even develop foot deformities including bunions, hammertoes, and flat feet.

Related:Here’s How Your Feet May Change After Walking Barefoot

Diagnosis

When your child has a well-visit, their pediatrician will check the angles and flexibility of their lower extremities. This exam will involve not only observing what they look like, but also gently moving their legs and feet to see how flexible they are. Your provider also will determine whether or not they can manually adjust your child's foot to a correct position.

Depending on your child's level of flexibility, the pediatrician will either describe their lower legs and feet as flexible, semi-flexible, or rigid. For example, if your child's forefoot can be passively overcorrected to reach abduction—or away from the midline of their body—then this is called a flexible deformity. Meanwhile, being unable to move their foot to a neutral position would be considered rigid.

Your child's pediatrician also will observe the angle of your child's hip and femur bone as well as the angle of their knee and tibia. And, if your child is old enough, they will watch them walk and run. One characteristic they look for is a "windmill" or "eggbeater" pattern where their lower leg pushes off and swings laterally when running.

Finally, they will talk to you about any history of intoeing in your family as well as consider whether or not there are any underlying conditions. If warranted, they may refer you to a pediatric orthopedist or podiatrist—which is one of the most common referrals these providers receive. Most of the time, a referral is not needed, though.

Related:6 Key Medical Scans and What They Should Cost

Treatment

Usually, intoeing gets better over time without any type of intervention or treatment. In fact, research indicates that when evaluated, most kids with intoeing have normal rotation of their joints and the bones are structured as expected. Consequently, if your child's condition is within normal measurements, their intoeing will likely resolve spontaneously as they grow and will not require any treatment.

Even X-rays and other similar tests are not routinely ordered—unless your healthcare provider wants to look for another possible cause. There also is no need orthotics; and, rarely, is surgery necessary—unless they are older than 8 and have severe deformities that are causing them problems.

However, if your baby's lower legs are rigid and difficult to straighten, your pediatrician may refer you to a pediatric orthopedist. Depending on their findings, they can sometimes recommend a series of casts applied over a period of three to six weeks. The primary goal is to correct the intoeing before your child starts walking.

As your child gets older, if their intoeing is disrupting the way they walk or run, causing them to fall quite a bit, or is causing them pain, your healthcare provider may refer you to a pediatric orthopaedic surgeon.

To start, this specialist may suggest physical therapy. But if that does not resolve the problem they may discuss surgery with you. While surgery is not normally recommended, it is sometimes considered in kids who are older than 10 and have severe symptoms.

As for gait plates and orthotics, research is limited regarding the usefulness and effectiveness of these devices. Most of the time, pediatricians and other healthcare professionals do not recommend using them.

Can You Prevent Pigeon Toes?

Because intoeing occurs as part of your child's normal development—or even during pregnancy—there is not much that you can do to prevent the condition. Additionally, there is no evidence to support using special shoes or orthotics to prevent intoeing.

In most cases, intoeing is a benign condition that will correct on its own. For this reason, your pediatrician will probably just keep an eye on the condition while simultaneously reassuring you that what your child is experiencing is nothing to worry about.

When to See a Healthcare Provider

Experiencing intoeing—or being pigeon-toed—by itself does not usually cause any symptoms. It is unlikely to cause arthritis. In fact, intoeing should correct itself before your child reaches adolescence.

That said, if your child is in pain, has a limp, or is having trouble walking, it is important to talk to their pediatrician about what you are witnessing. After an evaluation, they may refer you to a pediatric orthopedist, or you can ask to be referred to one if you want a second opinion.

A Quick Review

Pigeon toes—or intoeing—is a common condition that impacts babies and young children and does not usually require any type of treatment or intervention. Most of the time, it will correct on its own, unless your child has an underlying condition like cerebral palsy or hip dysplasia. In those situations, they may need physical therapy or another type of treatment to address the issue. It is also important to let your provider know if your child tends to fall a lot, has a limp, or appears to be in pain. They can refer you to a pediatric orthopedist who can help you determine the best course of action.

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