Pigeon Toes / Intoeing
Understanding Pigeon Toes - Intoeing
In-toe or pigeon-toed is when the feet turned inwards as we walk. It is common in childhood and is usually outgrown. This is a very common clinical presentation which may involve one or both feet. It can be observed as part of a child’s normal development however, some forms of intoeing can create additional problems and may warrant intervention. With intoeing, children might be prone to tripping or may look awkward with walking or running and may have difficulty finding shoes that fit due to the curve of their feet.
What is the cause of pigeon toes?
There are few common causes of intoeing:
Metatarsus Adductus (curved foot)
It is a common foot noted at birth that causes the front half of the foot, or forefoot, to turn inward. In metatarsus adductus, the long bones of the foot deviate inwards giving the foot a curved or banana-shaped appearance. It can affect one or both feet and is thought to be related to the position of the baby in the mother’s uterus.
Internal Tibial Torsion (twisted shin bone)
This condition is where the thigh bone turns inwards between the knee and the ankle. It is very common in infancy and childhood as part of their bony development. Some inward twist of the tibia is normal in babies, however in some children, the twist does not straighten and they may still in-toe when beginning to walk, this tends to correct with normal growth by about the age of six. Internal tibial torsion can be hard to notice until your child starts to walk, it causes excessive foot pronation (rolling in) and genu valgum (knock knees).
Internal Femoral Torsion (twisted thigh bone)
This condition is where the thigh bone turns inwards between the hip and the knee. This is normal in young children, especially children between the ages of three to six but usually slowly corrects itself by the age of nine or ten. It causes the feet to turn inward and cause a “pigeon-toed” appearance.
Tight Internal Hip Rotator Muscles
The main muscles that internally rotate the femur (thigh bone) at the hip are the tensor fascia lata and the gluteus medius. When these muscles are tight it can limit external rotation and therefore cause internal rotation of the whole leg. This position of the femur causes the knee and feet to turn inwards giving the “pigeon-toed” appearance. Tight internal hip rotators are often found in conjunction with internal femoral torsion.
When to see a podiatrist or specialist about in-toeing?
If the pigeon toe is still apparent by the time reaches 8 years old or if it is causing the child to fall more often than normal, is affecting participation in daily activities or the feet are stiff and not improving with time, medical help should be sought. Most parents seek medical advice regarding pigeon toe as part of their child’s routine examinations.
How is intoeing treated?
Treatment for intoeing gait is dependent on the contributing factors and the severity of the condition. Early intervention can assist in preventing future complications arising from poor foot posture and gait patterns. Common treatment options include:
changes to sitting, sleeping positions
stretching/strengthening program for specific muscle groups
bracing / splinting
Book in and see our podiatrist today. Should you suspect your child may be intoeing or would like a general lower limb assessment. Early intervention is key in preventing future complications. Let us help your child to put their best feet forward today!
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