Short answer: Pigeon toes, or in-toeing, is when a child walks with the feet pointed inward. It usually comes from one of three places: the foot (metatarsus adductus), the shin (tibial torsion), or the thigh (femoral anteversion). The large majority of cases are painless and correct themselves as the child grows, often by age eight to ten, without special shoes or orthotics. Pain is not normal with pigeon toes, and it is the main reason to have your child evaluated.
If you have noticed your child walking with their toes turned in toward each other, you are looking at a common gait pattern, and it is one of the more frequent reasons parents bring their little ones to CarePlus Foot & Ankle Specialists. It can look awkward and cause the occasional trip, but the good news is that most children outgrow it without any major intervention. Here is what causes pigeon toes and how to manage it.
The three causes of pigeon toes
There are a lot of misconceptions about what causes in-toeing. It typically stems from one of three areas: the foot, the shin, or the hip. Where the twist is located determines the treatment and the timeline for correction.
- Metatarsus adductus. A curve in the foot itself, often from the cramped position in the womb. You will notice the outside edge of the foot has a C-shape.
- Tibial torsion. An inward twist of the shinbone. It is very common as toddlers begin to walk and usually straightens as they grow taller.
- Femoral anteversion. An inward twist of the thigh bone. If your child likes to sit in a W position on the floor, this is often the culprit.
What parents should know
Understanding the reality of in-toeing saves a lot of unnecessary worry. These are the most important takeaways for your child’s foot health.
- It usually resolves on its own. The vast majority of cases self-correct according to the NIH. As your child’s bones mature and muscles strengthen, in-toeing typically disappears by age eight to ten.
- Tripping is common and temporary. Pigeon toes can make children trip a bit more, because the inward foot can catch on the opposite heel. This is usually just a passing phase of clumsiness.
- Discourage W-sitting. Encourage cross-legged sitting instead. W-sitting puts extra stress on the hips and can slow the natural straightening of the legs.
- Pain is not normal. Pigeon toes should not hurt. If your child complains of aching feet, legs, or hips, it is time to see a podiatrist.
- Special shoes are rarely needed. Most in-toeing does not require orthopedic shoes or custom orthotics. Flexible, well-fitting sneakers that allow natural movement are usually the best choice.
When to see a podiatrist
You can usually let nature take its course, but a professional evaluation gives peace of mind. See a podiatrist if the in-toeing is painful, if it is getting noticeably worse, if it affects only one side, or if it has not improved by age eight. A podiatrist can measure the exact degree of the twist and rule out any underlying hip or neurological issue. In some cases, specific stretches or physical therapy can help the process along.
At CarePlus Foot and Ankle Specialists in Bellevue, Dr. Hubert Lee can evaluate your child’s gait and tell you honestly whether to simply monitor it or take the next step. Call (425) 455-0936 or schedule an appointment online.
Frequently Asked Questions
Is pigeon toeing in children serious?
In most children it is not serious. It is usually a normal variation in how the foot, shin, or thigh bone is rotated, and it corrects on its own as the child grows. It only needs attention if it is painful, worsening, one-sided, or not improving with age.
At what age do pigeon toes go away?
Most cases resolve on their own by about age eight to ten as the bones mature and muscles strengthen. Some forms improve even earlier. If in-toeing is still significant after that age, it is worth a professional evaluation.
Should my child wear special shoes for pigeon toes?
Usually not. Most in-toeing does not require orthopedic shoes, braces, or custom orthotics. Flexible, well-fitting sneakers that allow natural movement are typically the best choice. Special devices are reserved for specific, evaluated cases.
When should I worry about my child’s in-toeing?
See a podiatrist if your child has pain, if the in-toeing is getting worse rather than better, if it affects only one leg, or if it has not improved by age eight. Pain in particular is not normal and should be checked.
This article is for general education and is not a substitute for individual medical advice. If your child has foot pain or you have concerns about their gait, see a qualified clinician for an evaluation.