Pigeon Toed, also called in-toeing, is when your feet point inward instead of forward. Pigeon toes are common in infants.
The condition generally resolves on itself in most cases without treatment.
Pigeon Toed has multiple names: you can find it also as “Metatarsus Adductus and the Metatarsus Varus, they are all the same group of the FFA – ForeFoot Adduction.
What is Pigeon Toed?
With pigeon Toed, your child’s toes point toward each other instead of forward. Pigeon toes are commonly caused by bones or joints that don’t point the right way (misaligned). Also called in-toeing, pigeon toes may be noted as your child begins walking.
It’s normal for parents to worry about their children, especially when they are babies, and can’t tell you if something hurts. (1) But pigeon toes don’t cause pain. In most cases, pigeon toes resolve on their own without causing long-term issues.
The Pigeon Toed is similar to Metatarsus adductus and metatarsus varus, also called FFA- Forefoot adduction, a well-known malformation that meets 5-7% of newborns worldwide each year.
The pigeon Toed comes in 3 severities:
1- Mild severity: 85% of cases resolve themself and 15% are not.
2- Modern Severity: The majority of cases are not resolved themself and need medical treatment.
3- Sever Severity: Are not self-corrected without treatment,
How common are pigeon toes?
Pigeon toes are common in the first few years of life. As the condition usually gets better as children learn to walk, pigeon toes are less common as children reach adolescence. Infrequently, pigeon toes may last into adulthood.
How do pigeon toes affect my child’s body?
Your child’s feet may turn in at rest and/or when walking. Although this might look different to you, pigeon toes are quite common. Pigeon toes generally do not cause pain, and the condition should go away on its own as your child grows.
What causes pigeon toes?
When bones in the foot, shin, or thigh aren’t aligned, your child’s healthcare provider may use the term “pigeon toes” or in-toeing. (2, 3) There are three common causes of pigeon toes:
- Bones in the foot. The bones that connect your toes to your ankle are called metatarsals. Metatarsus adductus is a malformation in the midfoot that is present at birth (congenital). The toes point toward the center, giving the foot a “C” shape. This is a common cause of pigeon toes in babies younger than 12 months of age. Certain things may make your child more likely to have metatarsus adducts, including if your fetus was breached if there was not enough amniotic fluid (oligohydramnios), and family history.
- The shin bone (tibia). The most common cause of pigeon toes that develop between the ages of 1 and 3 is when the shin bone or tibia is turned inward (inward tibial torsion), toward the middle of the body. If your child’s tibia is inwardly rotated, they may appear bow-legged. This condition usually resolves on its own by the time your child is 5 years old.
- The thigh bone (femur). When your knee looks turned inward about your hip, it’s called femoral anteversion. It’s caused by an inward rotation of your thigh bone (femur). This condition can be passed on from parents to children. Femoral anteversion can also be the result of the position of your fetus — or crowding — in your uterus. Femoral anteversion is usually diagnosed between the ages of 3 and 6, and then it gradually decreases. (4, 5)
Rarely, other problems can be associated with pigeon toes. These include:
- Cerebral palsy.
- Clubfoot (talipes equinovarus).
- Developmental abnormalities of the hip joint.
- Skewfoot and other rare malformations.
What causes pigeon toes in adults?
For many children, pigeon toes develop in the womb.
Limited space in the uterus means some babies grow in a position that causes the front part of their feet to turn inward. This condition is called metatarsus adductus.
In some cases, pigeon toes occur as leg bones grow during the toddler years.
Intoeing present by age 2 may be caused by a twisting of the tibia, or shinbone called internal tibial torsion. A child age 3 or older may experience a turning-in of the femur, or thighbone, called medial femoral torsion.
This is sometimes referred to as femoral anteversion. Girls have a higher risk of developing medial femoral torsion.
What are the symptoms of pigeon toes?
In toddlers and young children with developing hips, walking with pigeon-toes is normal. Even when caused by femoral anteversion, inward-pointing toes usually straighten out on their own as children learn to walk.
Signs of femoral anteversion usually first become noticeable when a child is between 2 to 4 years old, a time when inward rotation from the hip tends to increase. The condition becomes most obvious when a child is 5 to 6 years old.
If your child has any of the following symptoms of femoral anteversion, it’s a good idea to talk with their doctor:
- pigeon-toed walking
- inability to walk with their feet close together and legs straight
- running with their legs swinging out
- tripping and falling often
How are pigeon toes diagnosed?
Pigeon toes are often diagnosed by healthcare providers during routine well-child check-ups.
They’ll conduct a physical exam and ask about your child’s medical history. If your child has started walking, your healthcare provider will observe them, looking carefully at the angles of their feet, ankle, knees, and hips. Healthcare providers might also watch older children run. (2)
The doctors should diagnose the pigeon toe malformation when the child is born and treat it in the treatment window which is under the age of 9 months.
What tests will be done to diagnose pigeon toes?
Your doctor may also want to get images of your child’s feet and legs. Imaging tests may include X-rays or CT scans to see how the bones are aligned.
A type of X-ray video called fluoroscopy can show the bones in your child’s legs and feet in motion. A pediatrician may be able to accurately diagnose the cause of your child’s pigeon toes.
Or you may need to see a specialist in pediatric orthopedics if the condition appears to be severe. (2, 6)
How are pigeon toed treated?
As written at the beginning of this article, most cases of pigeon toes get better on their own, however, it’s crucial to treat all of them because we can’t predict which cases will resolve by themselves and which cases will not it’s a gamble.
Depending on the cause of pigeon toes, your healthcare provider may just watch and wait. Or they might recommend exercises or physical therapy to fix pigeon toes. (7, 8) Very rarely, other treatments may be considered, including:
- Serial casting: If the metatarsus adductus is severe or doesn’t improve on its own, your child’s healthcare provider may suggest a series of casts to stretch and lengthen their muscles. (9) As you might imagine, it’s very important to keep your baby’s casts clean and dry. But it’s no small task. The casts may also cause itching and foul odors. Call your child’s healthcare provider to discuss any questions about serial casting.
- Surgery (osteotomy): If severe tibia-related pigeon toes are causing functional problems as your child approaches adolescence, your healthcare provider may refer you to a pediatric orthopedic surgeon to discuss the possibility of surgery. (10) Surgery isn’t generally recommended for femoral anteversion but may be considered for children older than 11 with severe symptoms.
- The UNFO brace– The UNFO brace is a revolutionary treatment method, invented by Israeli MD, Dr. Izak Daizade, UNFO is the most advanced treatment option today for infants under the age of 9 months.
Can Pigeon Toed be prevented?
When it comes to prevention, we look at the risk factors related to a disease in terms of things you can change and things you can’t change. The causes of pigeon toes aren’t something you can do anything about. (7) They include:
- A twin or multiple pregnancies.
- Not enough amniotic fluid (oligohydramnios).
- A large fetus.
- Breech position.
- Normal variant.
The good news is that pigeon toes rarely cause pain and tend to get better on their own.
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- Faulks S, Brown K, Birch JG. The spectrum of diagnosis and disposition of patients referred to a pediatric orthopedic center for a diagnosis of intoeing. Journal of Pediatric Orthopaedics. 2017;37(7):e432-e5.
- Lincoln TL, Suen PW. Common rotational variations in children. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2003;11(5):312-20.
- Staheli LT, Lippert F, Denotter P. Femoral anteversion and physical performance in adolescent and adult life. Clinical Orthopedics and related research. 1977(129):213-6.
- Karol LA. Rotational deformities in the lower extremities. Current opinion in pediatrics. 1997;9(1):77-80.
- Panel SA. Referral to pediatric surgical specialists. Pediatrics. 2014;133(2):350-6.
- Briggs R, Carlson W. The management of intoeing: a review. South Dakota journal of medicine. 1990;43(2):13-6.
- Nourai MH, Fadaei B, Rizi AM. In-toeing and out-toeing gait conservative treatment; hip anteversion and retroversion: 10-year follow-up. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2015;20(11):1084.
- Uden H, Kumar S. Non-surgical management of a pediatric “intoed” gait pattern–a systematic review of the current best evidence. Journal of multidisciplinary healthcare. 2012;5:27.
- Sielatycki JA, Hennrikus WL, Swenson RD, Fanelli MG, Reighard CJ, Hamp JA. In-toeing is often a primary care orthopedic condition. The Journal of pediatrics. 2016;177:297-301.