If you are having any symptoms or have any questions, please call 811 to speak with a registered nurse 24 hours a day.

OVERVIEW

What is intoeing?

Most people’s feet point straight ahead or outward. Some people, however, have feet that point inward. This is called intoeing. It is also called “pigeon toes.” Intoeing is very common in young children. Most of the time, intoeing goes away without treatment. In a few children, it doesn’t get better on its own and must be treated.

SYMPTOMS

When your child has intoeing, their feet point inward toward each other. The condition usually does not cause pain or any other symptoms.

CAUSES & RISK FACTORS

What causes intoeing?

There are three causes of intoeing in healthy children.

Internal tibial torsion. This is the most common cause of intoeing. Internal tibial torsion is a twist in the tibia (the leg bone between the knee and the ankle). Some inward twist of the tibia is normal in babies. Usually this twist straightens out during the baby’s first year. In some children, the twist doesn’t straighten enough for the feet to point straight ahead or outward, and these are the children who still intoe when they begin walking. Leg bones usually continue to grow straighter until the child is 6 to 8 years old.

Excess femoral anteversion. Excess femoral anteversion is an inward twist in the femur (thigh bone). All babies are born with some inward twist of the thigh bone. This cause of intoeing usually shows up in children between the 2 and 4 years of age, after children begin walking. It can get worse during early childhood.

Metatarsus adductus . Metatarsus adductus is a curve in the foot. This is best seen if you look at the sole of your child’s foot. If your child has metatarsus adductus, you may notice it while they are still a baby. The curve in the foot is probably caused before the baby is born, when the feet are pressed into this position inside the uterus. In 9 out of 10 children with this problem, the feet straighten as the children grow up.

DIAGNOSIS

How is intoeing diagnosed?

Your healthcare provider will look at your child’s foot. They will watch the way your child walks. They may order tests, such as X-rays. This will help them determine if any bones are rotated.

PREVENTION

Can intoeing be prevented or avoided?

There is nothing that can be done to prevent intoeing in your child.

TREATMENT

How is intoeing treated?

Treatment depends on the cause of your child’s intoeing. In most cases, treatment is not necessary. The problems resolve over time.

Internal tibial torsion

Most healthcare providers don’t give any treatment for internal tibial torsion in young children. Braces and special shoes are not helpful. They are expensive. Children often don’t like to wear them, so they are seldom used. In a small number of children, the twist in the tibia doesn’t go away. Even if the twist remains, it hasn’t been shown to cause arthritis or problems with running and jumping.

Sometimes appearance is a problem. In this case, the treatment is surgery to cut the bones and turn (rotate) the bones outward, so the feet point straight. Very few children have to have this surgery. This is something that must be carefully discussed with your child’s healthcare provider.

Excess femoral anteversion

Excess femoral anteversion usually gets better by itself. In most children, the feet will point straight ahead or outward by the time they are 10 years old. Braces or shoe modifications typically won’t help. In a few children with a very strong inward twist of the thigh bone, an operation is possible to cut this bone and twist it outward, so the feet will point straight ahead. Surgery is only considered in very severe cases.

Metatarsus adductus

Your healthcare provider may show you how to stretch the baby’s foot to help the foot get straighter. If the foot shape is very curved or the curve doesn’t go away, your healthcare provider may treat your baby by putting casts or braces on the feet to help stretch them into a straight position. If the feet still have some curve after treatment, it will not cause any problems with running and playing. It is not painful.

Living with intoeing

Intoeing usually doesn’t cause serious problems, even if it doesn’t go away by itself. Sometimes children with intoeing have problems getting shoes that fit, because of the curve of their feet. This fitting problem might make parents consider treatment for their child. Intoeing doesn’t cause arthritis or clumsiness.