In-toeing

In-toeing (sometimes called being “pigeon toed”) is a very common childhood condition and is considered part of normal development. Most children do not need any treatment for in-toeing and will outgrow it on their own over time.

Signs, symptoms and types of in-toeing

You may notice your child’s foot or feet turning inward, or an unusual posture when they sit or walk.

The three most common causes of in-toeing originate from the:

• Foot
• Shin
• Thigh bones

Metatarsus adductus

Most common in infants and toddlers

In-toeing due to the foot is called metatarsus adductus. This is the most common cause of in-toeing in children ages birth to two years old. “Metatarsus” refers to the foot bones, and “adductus” means turned inward.

Because a baby’s foot is so flexible, this condition doesn’t typically require any treatment and will correct itself. In some cases, if the baby’s foot is rigid, your orthopedist might recommend a series of casts or a special shoe to help with their foot positioning.

Tibial torsion

Most common in children 18 months - 4 years 

In-toeing at the tibia (shin bone) is called tibial torsion, which means the tibia is twisted inward. This causes the foot to turn inward as well. This type of in-toeing is most common in small children ages 18 months to 4 years old. Most families notice it when their child begins to walk. Tibial torsion usually corrects itself with age. 

Femoral anteversion

Most common in older children

Twisting of the femur (thigh bone) is the most common cause of in-toeing in older children. It is slightly more common in girls than boys. Femoral anteversion consists of rotation in the upper portion of the femur.

Like other types of in-toeing, femoral anteversion usually improves over time and corrects itself by the time your child is 10 to 12 years old. Sitting in the “W” position does not worsen the condition.

Treatment for in-toeing

In the past, in-toeing was treated with methods such as bracing, stretching and special shoes. Recent research shows that the improvements credited to these treatments were actually due to normal growth.

Less than 1% of children need treatment for in-toeing.

The only way to definitively correct the rotation of the tibia or femur is through a surgical procedure called a rotational osteotomy. During the procedure, the surgeon cuts the bones and places them in the preferred position so that they heal correctly.

Surgery is not performed until the children are older. Surgery is then only considered if the position of the bones causes pain, limits their activities or if the correction does not occur on its own at the age the provider expects it to.