Pigeon Toed

Intoe­ing in infants may be noticed even before walk­ing as they may have a cur­va­ture to their feet induced by intrauter­ine pres­sure. Intoe­ing in young chil­dren may be not­ed as the child seems clum­sy and stum­bles as a result of their toes catch­ing on the oth­er heel while walk­ing or run­ning. Old­er chil­dren may have an awk­ward gait, trip often and be teased by peers for being pigeon-toed. A child whose intoe­ing is asso­ci­at­ed with pain, swelling or a limp should be eval­u­at­ed by their doctor.

What caus­es Intoeing?

There are three com­mon con­di­tions caus­ing intoe­ing: a curved foot (metatar­sus adduc­tus), a twist­ed shin (tib­ial tor­sion), and a twist­ed thigh bone (increased femoral antev­er­sion). Each of these con­di­tions can occur by them­selves or they can occur togeth­er. Pre­ven­tion is usu­al­ly not pos­si­ble because these are hered­i­tary. Often times these con­di­tions will improve as chil­dren grow but in more severe cas­es, ear­ly inter­ven­tion is impor­tant to reduc­ing the amount of defor­mi­ty that may cause pain and con­cerns lat­er in life.

Treat­ment for Metatar­sus Adductus

Metatar­sus adduc­tus improves by itself most of the time, usu­al­ly over the first 4 to 6 months of life. Severe defor­mi­ty, if diag­nosed ear­ly, is treat­ed with cast­ing and spe­cial shoes. The suc­cess rate of treat­ment is very high in babies 6 to 9 months. Sur­gi­cal cor­rec­tion may be required or con­sid­ered in chil­dren over the age of 4 if the child has a stiff, resid­ual deformity.

Treat­ment for Tib­ial Torsion

Tib­ial tor­sion almost always improves with­out treat­ment, and usu­al­ly before school age. Some physi­cians choose to accel­er­ate the cor­rec­tion process by using a Denis-Brown bar. A child whose intoe­ing is caused by a severe twist in the tib­ial bone that is caus­ing sig­nif­i­cant prob­lems with walk­ing may require surgery. This is usu­al­ly per­formed in chil­dren who are at least 8 to 10 years of age.

Treat­ment for Increased Femoral Anteversion

Increased femoral antev­er­sion is expect­ed to spon­ta­neous­ly cor­rect in almost all chil­dren as they grow old­er. Stud­ies have found that spe­cial shoes, braces and exer­cis­es usu­al­ly do not help but in severe cas­es, the physi­cian may choose to use a Denis-Brown bar to accel­er­ate the process. Surgery is usu­al­ly not con­sid­ered unless the child is old­er than 9 or 10 and has a severe defor­mi­ty that caus­es an unsight­ly gait and tripping.