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OVERVIEW

What is intoeing?

Most people’s feet point straight ahead or outward. In some people, however, the feet point inward. This is called intoeing (say “in-toe-ing”), also called “pigeon toes.” Intoeing is very common in young children. Most of the time, intoeing goes away without any treatment at all. In a few children, it doesn’t get better on its own and must be treated.

CAUSES & RISK FACTORS

What causes intoeing?

There are three causes of intoeing in healthy children. They are metatarsus adductus, internal tibial torsion and excessive femoral anteversion.

What is 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.

What is internal tibial torsion?

Internal tibial torsion is a twist in the tibia (the leg bone between the knee and the ankle). Parents usually notice internal tibial torsion about the time their child begins to walk. 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.

What is 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.

TREATMENT

How is intoeing treated?

Treatment depends on the cause of your child’s intoeing.

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.

Healthcare providers have different ideas about when the casts or braces should be put on, but many think that if the feet are still curved when the child is 4 to 6 months old, casting or bracing should be started. It should be finished before the child reaches normal walking age. If the feet still have some curve after treatment, it will not cause any problems with running and playing, and is not painful. A strong curve can cause problems with fitting shoes, which is the main reason for using casts or braces.

Internal tibial torsion

Special splints, braces, or shoes do not correct the twist, and may in fact be harmful. Most healthcare providers don’t give any treatment for internal tibial torsion in young children. 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.

COMPLICATIONS

Is intoeing serious?

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.

Very few children have a severe twist in the tibia (leg bone) or femur (thigh bone), which might bother them because it looks bad. Sometimes this problem requires surgery.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What is the likely cause of my child’s intoeing?
• How severe is my child’s intoeing?
• What is the best treatment option?
• Will my child need to wear a brace or special shoes?
• Is there anything I can do at home to help treat my child’s intoeing?
• Is it safe for my child to run/jump/etc.? What kinds of activities are ok?
• Will intoeing cause any long-term problems for my child?

FOR MORE INFORMATION

IWK website:
http://www.iwk.nshealth.ca/childrens-health/flat-feet-intoeing-bow-legs-and-knock-knees