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Pigeon Toed

Dr. Marc Feder

Reviewed by
Dr. Marc Feder

Did you know Babe Ruth intentionally ran the bases pigeon-toed because he believed it helped him run faster? Did you know Paris Hilton has mastered a pigeon-toed photo stance to hide her size 11 feet? The term pigeon-toed (medically known as in-toeing) is used to describe a person who points their toes inward while standing or walking.

pigeon toed

pigeon toes by qwrrty, on Flickr

Severe cases of pigeon toe can be considered a form of clubfoot, but in most cases the patient outgrows the condition before reaching adulthood. In other cases, spinal manipulation in the lumbar region (the lower part of spine) is used to correct the problem, while severe cases require surgical repair. Pigeon toe is most common in infants and toddlers, and is not necessarily a problem; the term only refers to the way the toes point when walking. This condition is not said to be painful or bothersome, nor is it known to cause additional medical problems such as arthritis. In fact, it is sometimes considered beneficial. It seemed to work for Babe Ruth.

Symptoms of Pigeon Toe

Here is a look at the symptoms associated with pigeon toe:

  • Feet point inward, as if the toes are touching
  • Stumbling (severe cases)
  • Clumsiness

Alternate Names

In-toeing; false clubfoot; in-toe gait; metatarsus adductus; metatarsus varus;

What Causes Pigeon Toe?

Pigeon toe is caused by one of three conditions: Metatarsus adductus, tibial torsion, or femoral anteversion. Each condition is specific to its location. Here is a brief description of each:

The foot: Pigeon toes occur when the foot tends to resemble a kidney, or when the metatarsus adductus has an inward curve at the outer edge of the foot. If your child has this condition, you will probably notice it while your child is still a baby. Sometimes the doctor will try braces or special shoes while the child is still a baby (six to nine months old) to help manipulate the bones into growing straight. This condition will not clear up on its own. Metatarsus adductus requires treatment, the nature of which varies depending upon whether the condition is flexible or fixed. Most flexible cases respond to conservative treatment, which includes passive stretching, bracing, and specialized shoes. The fixed type requires serial plaster casting. If conservative treatment does not help, then reevaluation is in order to make sure the patient does not have true club-foot instead of metatarsus adductus. If conservative measures fail, surgical correction will be necessary, especially in cases of club-foot. The sooner the patient is diagnosed and treated, the better the outlook for the patient.

The knee: When there is an inward twist of the tibia bone, the shin is twisted. This is commonly seen in children learning to walk. Usually the leg straightens out within the first year of life, but some children may continue to walk pigeon-toed until the leg bone is done growing. Surgery may be necessary for children who do not outgrow this condition by the age of ten.

The hip: In some cases the femoral anteversion has an inward twist at the upper thighbone. The knee caps tend to point inward when the person is walking. Most children show this form of in-toeing between the ages of 2 and 4, after they have begun walking. Typically, a child will outgrow this condition by the age of 8.

Can Pigeon Toe Be Treated?

An infant’s foot is unlike a child’s or an adult’s foot, and changes are still occurring. Most diagnoses of metatarsus adductus or true club-foot in infants occur well before they even begin to walk, and these children need immediate treatment. An infant who does not have metarsus adductus or true club-foot will still appear to in-toe when they begin to walk. This is normal up to about the age of three, and it is because of the structural difference in the infant’s foot and the changes that have yet to occur in the leg (the tibia) or the femur (anteversion). As the child ages, their gait should begin to straighten. On the other hand, if the in-toeing continues after about age 3, this is concerning. Therefore, children should be examined regularly by a podiatrist to ensure that the bones are developing correctly and the child’s gait is progressing correctly. If the condition is asymmetrical, this is also cause for concern, and may indicate other developmental problems that are beyond the scope of this article.

When to See Your Doctor

If you notice that your child is pigeon-toed, you should consider seeing a podiatrist for an accurate diagnosis and a better idea of what to expect. If your child is pigeon-toed and you believe it is getting worse, or if the child has not outgrown the condition, you should contact your doctor. Remember that tripping and falling are normal parts of learning to walk and are not always the result of being pigeon-toed.

Complications of Pigeon Toe

Although this condition sometimes goes away on its own, in some cases, it does not. This causes complications for both the parents and the child. Thankfully, most complications are not serious, even if the child does not outgrow the condition. Shoes are typically the biggest complication. The parents of most pigeon-toed children are unable to find shoes that fit them properly because of the curve of their feet. This can be frustrating, and finding the right shoes can become costly for the parents. Children who are pigeon-toed may feel embarrassment if they walk differently than other children their age.

Talking to Your Doctor

Here are some questions you may want to ask your doctor about pigeon toes:

  • What is causing my child’s pigeon toe?
  • If braces and casts are not beneficial, what other non-surgical treatment options are available?
  • Should I wait until my child has turned 8 to consider surgery?
  • Which diagnostic testing should I expect during our next visit?
  • How often should I bring my child in for examination?
  • If surgery is necessary, who will perform the surgery?
  • What type of shoes do you recommend for my child while they are still growing out of this condition?
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Medical References:

  1. University of Iowa Healthcare, Pigeon Toe (in-toeing): http://www.uihealthcare.com/topics/bonesjointsmuscles/bone3447.html
  2. Evans Army Community Hospital, intoeing.pdf, http://evans.amedd.army.mil/peds/PDF/intoeing.pdf
  3. KidsHealth, Common Childhood Orthopedic Conditions, http://kidshealth.org/parent/medical/bones/common_ortho.html

This page was last updated on August 6th, 2014



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