Pediatric Orthopedics: Pigeon Toes

by admin on July 27, 2012

Pigeon toes (also called “in-toeing” or “metatarsus adductus” in the medical community) are a common feature of development of the foot and lower leg in toddlers and young children. To a certain degree, in-toeing is normal in the first few years of age, since development of the fetus requires the feet to be twisted inwards due to the shape of the uterus. As time goes on and further development occurs, the feet generally straighten out. Generally, though, there is a normal pattern that is followed and children who fall out of the usual progression are watched more closely.

After a child starts walking, in-toeing may be initially noted but in general, it should not interfere with the child’s ability to walk. If limping or tripping occurs relative to in-toeing, it should be treated rather than waiting to see if it will correct on its own.

Initial treatment consists of stretching the foot, which is done on a daily basis by the parents or responsible parties. If stretching fails to show improvement, then the next step is with specialized shoes or, in some cases, casts. Rarely is surgery required, and only if all else has failed.

It should be noted that rotation of the leg can also cause in-toeing (less commonly) and when this is the case there are braces that are typically worn at night that correct the problem, or again surgery if neglected or resistant.

Untreated, in-toeing can lead to problems later in life. Because the foot is designed for equal distribution of pressure across the ball, in-toeing results in a less efficient gait pattern that uses more energy for walking. Athletic ability, particularly running and jumping, is reduced. Shoe fit is also a problem, and generally produces bunions and hammertoes early in life. If the foot is very flexible, flatfoot can also result.

If your child walks pigeon-toed, make sure to bring it up with your pediatrician. If the problem resolves too slowly, referral will be made to a foot and ankle specialist. If there are already problems with the child getting around, you may need to consult with a foot and ankle specialist directly.


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