# Intoeing > Intoeing, or pigeon toes, means a child's feet point inward as they walk or run. It's usually a normal variation that improves as children grow, and most only need to be watched. Some signs need checking. Guide in [Children's feet](https://footanklelowerlimb.com.au/learn/topics/childrens-feet), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/intoeing Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 1 November 2026. Next review by 1 November 2027. - **Usually a normal variation:** most children's intoeing improves as they grow. - **Three possible sites:** the inward turn may start in the foot, the shin or the thigh. - **No special gear needed:** shoes, braces and inserts aren't needed for typical 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 ahead [1]. It's most common in infants and young children [2], and it's usually a normal variation, particularly in toddlers [3]. The turn can come from the foot, the shin or the thigh [1]. Over time it usually eases as a child grows [3]. 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 10 [5]. The foot and shin turns often come from how your child's legs were positioned in the cramped space of the womb [1]. Persisting or severe forms are probably genetic [6]. ## What does intoeing look like, and how is it diagnosed? What you notice is your child's feet turning inward when they walk or run [1]. 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 walk [2][6]. They'll also check the hips, shins and feet, which together make up the torsional profile (the set of leg measurements a clinician takes) [2][6]. This is usually enough to work out what's going on [2]. Scans such as X-rays aren't routinely needed; they're used only to rule out other problems [2]. ## What helps first, and do special shoes or braces work? For typical intoeing in a toddler, the first step is keeping an eye on it [1]. Most children improve as they grow and need no treatment [8]. 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 faster [1]. If the shin is the source, special shoes, splints, bracing or exercises to untwist the bone aren't needed either [4]. Most metatarsus adductus (the foot curving inward) is flexible, meaning it can be eased straight with gentle pressure, and it usually settles without treatment [9]. Flexible cases are best left alone [7]. This applies only when none of the warning signs apply [4]. ## 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 management [4][9]. One example is rigid metatarsus adductus, where the foot can't be eased straight with gentle pressure [9]. Special shoes, braces, splints or exercises still aren't needed for a shin twist [4]. If surgery is ever raised, it's a decision for the orthopaedic team, so talk through the risks and timing with them [10]. ## 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 10 [8][11][3]. Metatarsus adductus often settles by itself in the first 4 to 6 months of life [1]. A shin twist can take years to untwist [1]. Some children keep intoeing into adulthood, but it rarely causes major problems [8][12]. 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. ## Common questions ### Does W-sitting cause intoeing? It isn't clear. Femoral anteversion is often seen alongside W-sitting, but that doesn't show the sitting causes it. It's unclear whether discouraging habitual W-sitting helps, and trying to change how a child sits or walks may not help and can cause stress and anxiety. ### Does intoeing cause arthritis or back pain later? Usually not. Intoeing doesn't usually affect your child's physical activity, and it isn't usually linked with a higher chance of arthritis or back pain later in life. ## Further reading - [Intoeing on Clindice](https://clindice.com/intoeing) - [In-toe walking - Paediatric Orthopaedics - Oxford University Hospitals](https://www.ouh.nhs.uk/paediatricorthopaedics/information/conditions/in-toe-walking/), NHS - [What Causes Pigeon Toes?](https://my.clevelandclinic.org/health/diseases/22186-pigeon-toes-intoeing), Cleveland Clinic - [Intoeing](https://www.nuh.nhs.uk/intoeing/), NHS - [In-toeing or pigeon toe | Common Health Issues - Child 1 to 4 years | Child 1 - 4 years | Healthier Together](https://www.healthiertogether.nhs.uk/child-under-5-years/in-toeing-or-pigeon-toe), NHS - [Paediatric Orthopaedic Problems Age 0 – ≤15 years – GP Gateway](https://www.coventryrugbygpgateway.nhs.uk/pages/paediatric-orthopaedics/), NHS ## Sources 1. In-toeing · York and Scarborough Teaching Hospitals NHS Foundation Trust. https://www.yorkhospitals.nhs.uk/childrens-centre/your-childs-hospital-journey/therapy-services/physiotherapy/in-toeing/ 2. Lower Extremity Abnormalities in Children. · Rerucha CM, Dickison C, Baird DC · American Family Physician · 2017. https://pubmed.ncbi.nlm.nih.gov/28925669/ 3. Referring Young Children with Gait Anomalies to Physiotheraphy · plr.cht.nhs.uk. https://plr.cht.nhs.uk/download/389/Referring%20Young%20Children%20with%20Gait%20Anomalies%20to%20Physiotheraphy%20A4 4. In-Toeing in Children - Fact Sheet · cdn.wchn.sa.gov.au. https://cdn.wchn.sa.gov.au/downloads/WCH/children/orthopaedics/Intoeing-Fact-Sheet.pdf 5. Common rotational variations in children. · Lincoln TL, Suen PW · The Journal of the American Academy of Orthopaedic Surgeons · 2003. https://doi.org/10.5435/00124635-200309000-00004 6. In-toeing and out-toeing in children. · Staheli LT · The Journal of Family Practice · 1983. https://pubmed.ncbi.nlm.nih.gov/6842143/ 7. Metatarsus adductus: development of a non-surgical treatment pathway. · Williams CM, James AM, Tran T · Journal of Paediatrics and Child Health · 2013. https://doi.org/10.1111/jpc.12219 8. Paediatric orthopaedic referral guidelines · Department of Health (Victoria). https://www.health.vic.gov.au/sites/default/files/migrated/files/collections/policies-and-guidelines/v/vpon-ortho-referral-guide.pdf 9. Angular and Rotational Lower Limb Alignment Variations in Children: Practical Guidance for Paediatricians. · Vlaic J, Kruk A, Wasko MK · Medicina (Kaunas, Lithuania) · 2026. https://doi.org/10.3390/medicina62081499 10. Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases. · Walton DM, Liu RW, Farrow LD et al. · Journal of Children's Orthopaedics · 2012. https://doi.org/10.1007/s11832-012-0384-4 11. Leg and foot problems in children · NHS. https://www.nhs.uk/baby/health/leg-and-foot-problems-in-children/ 12. Rotational profile · NUH. https://www.nuh.nhs.uk/rotational-profile/ --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.