Intoeing

What is intoeing, and how common is it?

Intoeing (also called pigeon toes) is when a child's feet turn inward when they walk or run, instead of pointing straight ahead¹. It's most common in infants and young children², and it's usually a normal variation, particularly in toddlers³. The turn can come from the foot, the shin or the thigh¹. Over time it usually eases as a child grows³. It can help to watch how your child walks and runs, and notice whether one or both feet turn in.

What causes intoeing, and who gets it?

Intoeing can come from one of three places, or a mix of them: the foot (metatarsus adductus, where the foot curves inward), the shin (internal tibial torsion, an inward twist of the shin bone) or the thigh (femoral anteversion, an inward twist of the thigh bone)⁴. The usual cause changes with age: the foot in infants, the shin in toddlers, and the thigh in children under 10⁵. The foot and shin turns often come from how your child's legs were positioned in the cramped space of the womb¹. Persisting or severe forms are probably genetic⁶.

What does intoeing look like, and how is it diagnosed?

What you notice is your child's feet turning inward when they walk or run¹. In a baby, the front half of the foot may look curved inward while the heel looks normal (metatarsus adductus)⁷.

A podiatrist or doctor will take a history and watch how your child's feet turn when they walk²⁶. They'll also check the hips, shins and feet, which together make up the torsional profile (the set of leg measurements a clinician takes)²⁶. This is usually enough to work out what's going on². Scans such as X-rays aren't routinely needed; they're used only to rule out other problems².

What helps first, and do special shoes or braces work?

For typical intoeing in a toddler, the first step is keeping an eye on it¹. Most children improve as they grow and need no treatment⁸. For normal intoeing in a toddler, observation is all that's needed, and special shoes, braces or chiropractic manipulation don't make it improve any faster¹. If the shin is the source, special shoes, splints, bracing or exercises to untwist the bone aren't needed either⁴.

Most metatarsus adductus (the foot curving inward) is flexible, meaning it can be eased straight with gentle pressure, and it usually settles without treatment⁹. Flexible cases are best left alone⁷.

This applies only when none of the warning signs apply⁴.

What if intoeing isn't improving?

If your child's intoeing isn't improving, more home treatment isn't the answer. Rigid cases may need orthopaedic management⁴⁹. One example is rigid metatarsus adductus, where the foot can't be eased straight with gentle pressure⁹. Special shoes, braces, splints or exercises still aren't needed for a shin twist⁴.

If surgery is ever raised, it's a decision for the orthopaedic team, so talk through the risks and timing with them¹⁰.

How long does it take to improve, and will it come back?

For most children, intoeing improves as they grow, usually by about age 8 to 10⁸¹¹³. Metatarsus adductus often settles by itself in the first 4 to 6 months of life¹. A shin twist can take years to untwist¹. Some children keep intoeing into adulthood, but it rarely causes major problems⁸¹². There isn't a known way to stop it coming back, so it helps to keep an eye on how your child walks.

What can make it serious?

• Your child's foot shape is getting worse.
• Your pain is getting worse, or doesn't settle with rest, less activity or pain relief.
• You have lost weight without trying.
• You have pain at night or at rest that doesn't settle.
• Your child has a limp that hasn't improved after a week, limps without pain, or doesn't want to put weight on their foot.
• Your child has heel or ankle pain together with hip or knee pain, morning stiffness that lasts more than 20 minutes, or a foot that has started to turn outwards.
• Your child has a fever with a limp or a painful, red, hot or swollen joint, or seems very unwell with foot or leg pain.
• Your child suddenly has severe pain in one joint and is limping.
• You suddenly can't put any weight on your leg or foot, or have sudden severe hip pain or a change in the length of your leg.