Updated: Mar 1
Musculoskeletal Series Part 2: In-Toeing or "Pigeon-Toed"
Have you ever looked at your child when they stand or walk and wondered why their feet turn in and if this will be a problem for them? This is a common concern for parents as they watch their child grow. So let's discuss in detail what in-toeing or "pigeon-toed" is and if or when you need to be concerned.
What does "pigeon-toed" mean?
In-toeing, commonly know as "pigeon-toed", is when a child's feet turn inward when standing or walking. This can involve just one foot or both feet.
In-toeing is very common and tends to run in families. Furthermore, many talented athletes are "pigeon-toed", showing that, while this condition may be concerning to many parents, it does not typically limit normal functioning, even when running or playing sports.
Is not painful or uncomfortable
Will not interfere with your child's ability to walk, run, play, or be involved in sports
Does not typically require surgery or intervention (braces, special shoes, etc)
What causes in-toeing?
In-toeing can occur in three different ways. It can be due to the conditions: tibial torsion, femoral anteversion, or metatarsus adductus.
Tibial torsion refers to the lower leg bone turning inward, causing in-toeing of the feet. The specific cause of tibial torsion is unknown but it commonly runs in families. Tibial torsion may cause your child to trip or fall a little more often, especially at the end of the day or when they are tired. However, most children learn to compensate for this over time, so there is no need to restrict activities. Conversely, the more active they are, the more likely they will learn to compensate well for the condition (e.g. as can be seen with many extremely talent athletes who happen to have in-toeing)
Femoral anteversion is characterized by the upper leg, or thigh bone, turning inward at the level of the hip, leading to the appearance of in-toeing. It also often runs in families. Children with femoral anteversion may prefer to sit in a "W-position", where their knees face forward with their inner thighs on the ground, and feet pointing backward. While awkward for others, this sitting position may feel natural and comfortable for a child with femoral anteversion and they may have difficulty sitting in a typical cross-legged position. There is no need to discourage sitting in a "W-position" as there is no evidence to show that sitting in this position causes any harm to hips, knees, or any other part of the body. Children with femoral anterversion may also tend to kick their feet out to the sides when running.
Metatarsus adductus is an inward curvature in the middle part of the foot that can give the appearance of in-toeing, typically in infants. It is believed that this develops due to the positioning in the womb and is more common if a baby was breech position in the womb or if the mother had low levels of amniotic fluid. The foot and leg are usually flexible in this condition; if so, it typically resolves on its own in the first year of life. However, there is a rigid form of this condition, where the foot and leg are not flexible, that may require treatment.
Does my child need treatment for their in-toeing?
Most causes of in-toeing naturally improve over time but may not go away completely. By 8 to 10 years of age, your child's foot or leg alignment will likely not improve any further and will be in it's final positioning. However, while occasional tripping may occur, most children learn to compensate well for in-toeing and have no symptoms, such as pain. Therefore, there is typically no major cause for concern and there is no need to restrict activities. Many studies have suggested that in-toeing may even improve sports function, as in-toers tend to be more effective runners and jumpers.
In the past, bars, shoes, orthotics, and twister cables were used to treat in-toeing but these devices have not shown to have any added effect to the natural tendency toward partial or complete correction by 8 to 10 years of age.
When should I be concerned about my child's in-toeing?
There are a few, rare exceptions to in-toeing in children that may require intervention. When in-toeing is severe or worsening, treatment may be necessary.
Signs to be more concerned about your child's in-toeing include:
Your child has rigidity in their legs or feet, as if stuck in place and cannot freely move
Your child's in-toeing seems severe
Your child has tripped or fallen to the point of major injury
Your child's in-toeing seems to be getting worse over time
Your child has pain in their hips, legs, knees, or feet related to their in-toeing
Your child's pain keeps them from being normally active
If your child has any of these symptoms or if you are not sure, talk to your child's pediatrician.
Continue reading the Musculoskeletal Series for other related topics such as:
When Should My Baby Crawl and Walk? (coming soon)
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