Is Your Child Pigeon-Toed? How to Correct and Cope

If your little one’s feet point inwards instead of straight ahead, it’s not necessarily a cause for concern. That’s because intoeing (a.k.a. being “pigeon-toed”) is common in babies and young children for a variety of reasons. Tyler W. Christman, DO, a pediatric orthopedic surgeon at Riley Hospital for Children at Indiana University Health, explains some of the most common causes, the specific conditions linked to being pigeon-toed, and treatment options.

Causes & Conditions

If you notice that your child’s feet turn inward—usually it becomes apparent once they start walking—this means they’re pigeon-toed. It’s normally a trait that runs in families, so you or another relative may have also been pigeon-toed as a child. There are three conditions most commonly linked to intoeing.

• The first is called metatarsus adductus or curved foot, which is basically a foot that curves inwards from the middle foot area to the toes and is most common in infants. Severe cases may look like Clubfoot where the whole foot bends inward, but they’re not the same thing.
• Another condition linked to being pigeon-toed is tibial torsion, where the tibia bone in the lower leg turns inward and pulls the foot inward with it. This usually starts when your baby is in utero, because he has to bend his legs inward to fit into the tightening space in the uterus as he grows.  Your child’s legs usually rotate to the proper place after birth, the lower leg bones naturally untwisting as your child’s legs grow longer. You may not notice it until your child begins walking and, in severe cases, trips because of one foot catching on the opposite heel.
• The third condition most commonly connected to intoeing is when a twisted upper thigh bone causes the knees and the feet to turn inward when walking, also known as femoral anteversion. This “bow-legged” type appearance goes hand in hand with being pigeon-toed for this condition, and is most noticeable when a child is about five years old. Another clue that your child may be affected is if she often sits with her knees turned inward and feet facing outward in a “W” shape because it’s more comfortable for her to sit that way. “As the deformity corrects, it will become less comfortable and the child will no longer prefer to sit in this position,” says Dr. Christman.

When to See a Specialist

For most kids, intoeing should correct itself before they turn eight years old, and doesn’t usually require any special treatment. Being pigeon-toed by itself shouldn’t cause your child any pain and it won’t lead to other conditions, such as arthritis. If your child is experiencing pain or has a limp or trouble walking, it may be best to see an orthopedic surgeon for an evaluation.

Treatment Options

• Curved foot: The issue usually takes care of itself by the time your baby is six months old. If your little one still has a severe or particularly rigid curved foot by nine months old, your doctor may recommend casts or special shoes, which are very effective. Surgery isn’t usually needed.
• Twisted shin bone: The tibial torsion rarely requires treatment because the tibia bone usually untwists itself naturally as your child grows taller. If, however, tibial torsion remains when your child is around nine or 10 years old and it’s affecting his ability to walk, an orthopedic surgeon may reset the bone with surgery.
• Twisted upper thigh bone: Studies show that devices such as braces don’t help with femoral anteversion, but, again, it fixes itself in almost all children as they grow. In the rare case that surgery is needed, an orthopedic surgeon may cut the upper thigh bone (femur) to place it in the proper alignment. “This surgery is recommended only in older children with severe rotational deformity in which the intoeing causes the child to frequently trip or fall, or causes severe gait disturbances or problems walking and running,” says Dr. Christman. “Recovery is typically two to three months.”

-- By: Holly C. Corbett