| Pigeon Toe
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Pigeon Toe

Pigeon Toe

Pigeon toe, also known as intoeing, is described as a condition where the toes turn in when one is walking or running. It is more common in children than in adults, and most children grow out of it before hitting the teenage years. However, in some cases, the condition persists and requires surgical correction. Pigeon toes tend to be familial and may accompany other bone development conditions affecting the feet or legs.

The development of the pigeon toe can be traced to the womb for some patients. The position of the fetus can be such that the front part of their feet turns inward, a condition that is called metatarsus adductus. While in other children, this condition occurs as leg bones grow during the toddler years. If pigeon toe is present by age 2, the cause may be the twisting of the tibia, or shinbone, a condition known as internal tibial torsion. Pigeon toe occurring in children at or above age 3, it may be secondary due to turning-in of the femur, a condition called medial femoral torsion or femoral anteversion. Girls of that age are more predisposed to developing medial femoral torsion.

Children who have medial femoral torsion often sit with a “W” shape with their legs flat on the floor and their feet out to either side

In newborns with metatarsus adductus, the symptoms are visible at birth or soon afterward, with one or both of the baby’s feet will be turned inward, even at rest. The outer edge of the foot is often seen as curved as well. However, internal tibial torsion may not be that apparent until the child starts walking, which is when there is noticeable inward turning of the feet. Medial femoral torsion, on the other hand, is noticeable after age 3, but more obvious by age 5 or 6. Oftentimes, the foot and knee both showing inward turning as the child walks or even if they stand. Children who have medial femoral torsion often sit with a “W” shape with their legs flat on the floor and their feet out to either side.

It is a clinical diagnosis – physical examination which includes (if the child is old enough) getting them to stand and/or walk. Moving the child’s feet, feeling how the knees bend and look for signs that a twisting or turning is present in your child’s hips all help with the diagnosis. Sometimes, imaging tests, such as X-ray, fluoroscopy or CT scans can be performed to see how the bones are aligned.

Usually, no treatment is required for pigeon toe, as most children grow out of mild or even moderate intoeing reaching proper alignment on their own. But infants with serious metatarsus adductus may need a series of casts for inducing alignment once they are six months old. For most cases, tibial torsion or medial femoral torsion require no casts, braces, or special shoes. They usually resolve on their own. If, however, there is no real improvement by age 9 or 10, surgery may be necessary to align the bones properly.

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