| Intoe Gait – Pigeon Toes
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Intoe Gait – Pigeon Toes

Intoeing is a condition where the feet curve inward instead of pointing forward when running and walking. Also called pigeon toes, a child often outgrows this disorder naturally by age two years.


What can occur with severe intoeing?


With severe intoeing, the child often trips or stumbles when walking/running. However, intoeing is not linked to arthritis in adulthood, nor does it cause your child pain. In addition, intoeing does not interfere with learning to walk.


Can intoeing be fixed through surgery?


Parents often worry about the child’s intoeing. Many parents believe that infant or child intoeing will have permanent deformities during adulthood. Parents often inquire about surgery for the shape of the foot. However, in children under the age of eight years, intoeing corrects without surgery. In addition, children can go barefoot without problems.


What causes intoeing?


Three causes of intoeing include:

  • Tibial torsion – The child’s lower leg bone (the tibia) turns inward in a condition called tibial torsion. This is the cause of intoeing. Tibial torsion means that the tibia did not rotate into a turned-out position after birth. Tibial torsion improves before age of four years.
  • Femoral torsion – This is in-turning of the child’s upper leg bone (femur). With this condition, the knees point inward toward each other, which is called squinty patella. This condition is often seen among ages five to six years of age. The torsion occurs in the femur, which causes a ripple effect and foot pointing inward.
  • Metatarsus adductus – With this condition, the forefoot is twisted infoot in comparison to the rearfoot. This condition may resolve spontaneously after birth. It is treated using splitting, stretching exercises, and soft tissue massage. With this condition, severity ranges from mild to serious. The curved foot is often flexible in some people while rigid in others.


What are the risk factors for intoeing?


Research shows that intoeing runs in families. Also caused by medical problems or an acute injury. If a child trips when running or walking and running, then you should see the doctor right away.


How is intoeing treated?


Special shoes, splints, and exercise programs do not correct intoeing. However, surgery is considered after around age 8-10 years. This is only considered when then the intoeing causes significant walking problems. Doctors will only consider surgery when bow legs and knock knees straighten out as he child grows. Treatment options usually do not cause a major disruption or pose a severe health risk for the person later in life.


How common is intoeing?


Intoing problems are diagnosed during ages 3-6 years, for most children. In a recent study, researchers investigated frequency of intoeing problems and hip rotation degrees in nursery school children. They found that intoeing occurred in 6% of the children, with 76% of these cases being bilateral. The condition was more common in girls than boys with a ratio of 2.4:1. In addition, intoeing was found to be associated with a greater internal hip rotation and smaller external hip rotation.



Altinel L, Kose, KC, Aksoy Y, Isik C, et al. (2007). Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases. Acta Orthop Traumatol Turc, 41(3), 190-194.

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