Pigeon-Toe: What You Should Know

If your child walks with their feet turned inward at the toes, they may be described as being pigeon-toed. This "toeing in" of the feet occasionally occurs as your child is starting to learn to walk, and it may continue through toddlerhood. It is noticed more often in children than adults, but occasionally older people may experience it.

Pigeon-toed walking is rarely a major orthopedic problem, and most often it goes away without treatment. But there are times in which it may impact your child's lower extremities and hips. In these rare cases, bracing or surgery may be necessary to correct the problem.

This article explains pigeon-toed walking, the causes and conditions associated with it, and common treatments.

What Does It Mean to Be Pigeon-Toed?

If you notice your child's toes turn inward when they walk or run, then they may be pigeon-toed. There usually is no need to worry, as this condition likely is not permanent and will go away in a few years. Still, it is a good idea to check in with your healthcare provider to ensure your child is developing normally.

Occasionally, you may see an adult who walks with their toes turned in. This may be due to a birth defect, a weakness, or it may be a rare case of pigeon-toed walking as a youth that never went away.

Causes

There are several possible reasons for pigeon-toed walking. To be certain of the cause of your child's walking condition, visit your healthcare provider. A provider can assess your child's condition, make a diagnosis of pigeon-toed walking, and, if necessary, provide options for treatment, including:

• Metatarsus adductus: The metatarsals are the long bones of the forefoot. One common birth defect is a condition called metatarsus adductus. This is when the bones of the foot point inward, leading to pigeon-toed walking. A simple clinical examination and X-ray can confirm metatarsus adductus as a cause of pigeon-toed walking.
• Tibial torsion: Your shinbone is called the tibia, and in some children, the tibia is slightly twisted. The tibia can either turn outward or inward. When it twists inward, it may manifest as a pigeon-toed gait (how a person walks). Tibial torsion may accompany femoral anteversion, and it is diagnosed with an X-ray. Children with tibial torsion typically grow out of the problem and the pigeon-toed gait pattern goes away by age 4.
• Femoral anteversion: Your thigh bone is called the femur. If your femur turns inward and forward unnaturally where the femoral neck meets the body of the femur, it is called femoral anteversion. (An outward and backward rotation of your femur is called femoral retroversion.) This occurs in about 10% of children. Many children with femoral anteversion appear knock-kneed (a large gap between their feet when standing with knees together), and when they walk appear pigeon-toed. Femoral anteversion is diagnosed by a clinical examination and X-ray.

Symptoms

In most cases of pigeon-toes, the child does not complain of any pain. If pain is felt, it can include:

• Tight feeling in the calf muscles
• Ache on the outer edges of the feet
• Knee pain

Usually, you will notice pigeon-toes when your child is first learning to walk. Rest assured, your child most likely is not experiencing pain. They simply have feet and knees that turn inward when they walk and run.

When to See a Healthcare Provider

Visit your healthcare provider if you notice your child is walking pigeon-toed. A pediatrician or primary care provider can assess the situation and make recommendations to correct the child's gait.

Most children who are pigeon-toed begin walking and running normally after the age of 3 or 4, so a watch-and-wait approach to care is typically recommended.

You may have to take your child to a specialist, like an orthopedic surgeon, if they are complaining of pain while walking. If your child is not able to walk due to the inward turn of their feet, then you should visit a specialist.

Risk Factors

Pigeon-toed walking is not a preventable condition but rather one that develops during pregnancy. Causes may include:

• A pregnancy with twins or multiple births
• Breech position in utero (when your baby is positioned feet first)
• Lack of amniotic fluid
• Large fetus

None of these risk factors is readily modifiable, so there is no way to correct for pigeon-toeing as it develops. And in most cases, children who walk pigeon-toed simply grow out of the condition in time.

Diagnosis

If you and your healthcare provider suspect that your child is walking pigeon-toed, simple things can be done to diagnose the condition. Most cases are diagnosed by clinical examination. Your healthcare provider may palpate (examine by touch) your child's lower extremities, looking for signs of metatarsus adductus, tibial torsion, or femoral anteversion.

A gait analysis may be done as well. In this, your child's healthcare provider may watch how the child walks and look for signs of inward-pointing toes and knees when walking.

An X-ray may be taken to assess the degree of tibial torsion or femoral anteversion present.

Treatment

As stated previously, most cases of pigeon-toed walking simply go away in time. Typically by the age of 3 or 4, a normal gait will appear.

Other treatments for pigeon-toed gait may include:

• Physical therapy exercises and gait training: Exercises to stretch tight lower extremity muscles and strengthen hip and leg muscles may help improve pigeon-toed walking. (See a pediatric specialist before starting, as research shows that parental stretching of a newborn with metatarsus adductus offers very little if any, benefit.)
• Casting or bracing: Braces or serial casting (a procedure that helps children improve their range of movement) may be done to place your child's lower extremities in an optimum position as they are developing.
• Surgery: For cases in which tibial torsion is causing pigeon-toed walking, osteotomy surgery (cutting and/or removing bone) may be recommended to correct the structural deformity of the shin bone.
  

Summary

If your child is walking with their toes pointed in, they may be pigeon-toed. This condition is common, affecting about 1 in 5,000 children, and it typically is caused by abnormal birth positions in utero. Most of the time, pigeon-toes go away on their own with no treatment necessary.

A Word From Verywell

We all want our children to grow and develop normally, but sometimes slight problems may lead to noticeable functional characteristics. Pigeon-toed walking is one of those problems. Mild changes in bone shape and positioning usually cause pigeon-toes. Often, it subsides in a few years as your child continues to develop. A watch-and-wait approach to care is typically all that is needed in cases of pigeon-toed walking.