Children who walk with their feet turned in are described as being “pigeon-toed” or having “intoeing.” This is a very common condition that may involve one or both feet, and it occurs for a variety of reasons.
Intoeing during infancy
Infants are sometimes born with their feet turning in. If this turning occurs from the front part of their foot only, it is called metatarsus adductus.
Most commonly it is due to the foot being positioned in a certain way inside the uterus before the baby is born. You can suspect that metatarsus adductus may be present if:
- At rest, the front portion of your infant’s foot turns inward.
- The outer side of the child’s foot is curved like a half-moon.
This condition is usually mild and will resolve before your infant’s first birthday. Sometimes it is more severe, or accompanied by other foot deformities that result in a problem called clubfoot. This condition requires a consultation with a pediatric orthopedist, and there is extremely effective nonoperative treatment with early casting or splinting.
Intoeing in later childhood
When a child is intoeing during their second year, this is most likely due to inward twisting of the shinbone (tibia). This condition is called internal tibial torsion.
When a child between ages 3 and 10 has intoeing, it is probably due to an inward turning of the thighbone (femur), a condition called medial femoral torsion. Both of these conditions tend to run in families.
Treatment for intoeing
Some experts feel no treatment is necessary for intoeing in an infant under 6 months of age. For severe metatarsus adductus in infancy, early casting may be useful. Studies show that most infants who have metatarsus adductus in early infancy will outgrow it with no treatment necessary.
If your baby’s intoeing persists after 6 months, or if it is rigid and difficult to straighten out, your doctor may refer you to a pediatric orthopedist, who may recommend a series of casts applied over a period of 3 to 6 weeks. The main goal is to correct the condition before your child starts walking.
Intoeing in early childhood often corrects itself over time, and usually requires no treatment. But if your child has trouble walking, discuss the condition with your pediatrician, who may refer you to an orthopedist. In the past, a night brace (special shoes with connecting bars) was used for this problem, but it hasn’t proven to be an effective treatment.
Because intoeing often corrects itself over time, it is very important to avoid nonprescribed “treatments” such as corrective shoes, twister cables, daytime bracing, exercises, shoe inserts, or back manipulations. These do not resolve the problem and may be harmful because they interfere with normal play or walking. Furthermore, a child wearing these braces may face unnecessary emotional strain from her peers.
That being said, if a child’s intoeing remains by the age of 9 or 10 years old, surgery may be needed to correct it.