HealthInfo Waitaha Canterbury

Pigeon toes (intoeing)

Matiwae whakaroto

Pigeon toes (also called intoeing) is the term we use to describe walking with your feet turned inward. It happens in up to a third of young tamariki (children) and is usually caused by the shape of their growing bones. It usually goes away by the time a tamaiti (child) is 16, when they stop growing.

Pigeon toes often run in families. Parents often worry about a tamaiti with pigeon toes, especially if people comment that they look awkward when running. Some people also think pigeon toes make tamariki trip up more, but there is no evidence that this happens.

Causes of pigeon toes

The cause of pigeon toes can be in three places: the feet, the lower leg or the thigh.

Feet

The outside edges of most feet are straight, but some children's feet curve inwards. This is called metatarsus adductus (met-are-tar-suss a-duck-tuss) and is thought to be caused by the position they were in while developing in their mother's womb.

Unlike club foot, when children have metatarsus adductus, their feet are generally very supple and can be straightened with gentle pushing by a doctor, physiotherapist or podiatrist.

Most tamariki with this condition grow out of it by age 3 or 4 years without any treatment.

Some stretching may help pēpi (babies) with a more pronounced curve. While it is not necessary to do this, some families feel it helps. The stretches are simple and your doctor, physiotherapist or podiatrist can show you what to do.

If the feet are very curved or do not improve, your tamaiti may need treatment with a cast.

If your child's feet seem to be curved, it's important to take them to a general practice team or podiatrist to check that it is not caused by something else, such as club foot.

Lower leg

In some tamariki the shin bone (or tibia) in their lower leg turns inwards. This is called internal tibial torsion. It's common in pēpi and tamariki, but tamariki usually grow out of it by the time they're 8 without any treatment.

Thigh

Some tamariki have a thigh bone (femur) that turns in. This is called internal femoral torsion or femoral anteversion.

All tamariki have this when they're born, but it gradually goes away as they grow. It usually gets better by the time the tamaiti is 10, but it can continue improving until they stop growing, between the ages of 14 and 16.

Tamariki with this condition often sit on the floor with their knees in front of them and their bottom between their feet, like in the photo below. This is sometimes called the W position. Older tamariki may run with their heels kicking outwards and their knees facing inwards.

Sitting in the W position doesn't appear to cause any long-term harm. Tamariki with femoral torsion sit like this because it's comfortable for them. They may not be able to sit cross-legged on the ground – or be uncomfortable when they do. They may be more comfortable sitting on a chair.

Sometimes this condition can be a sign of something more serious, such as cerebral palsy or a dislocated hip. This is especially the case if one side is different to the other. If these cases, it's important that your tamaiti gets the right treatment.

Helping my child with pigeon toes

There are some things you can do yourself that may help your tamaiti child grow out of the condition.

• Make sure your tamaiti has well-fitting shoes.
• Encourage them to avoid sitting in the W position. But if this is what is comfortable for them, you do not need to stop them altogether.
• Get them to stretch their hamstrings. This video shows how to do that.
• For young tamariki, make a game of bear walking (walking on their hands and feet) and penguin waddling (walking with their feet turned out). These will help to stretch and strengthen the muscles that aren't strong or flexible enough.
• Teach them to ride a bike.

Getting help for pigeon toes

Pigeon toes are normal in tamariki children . If your tamaiti has no other symptoms, they do not need any special treatment and you do not need to stop them doing anything. This can be difficult because well-meaning friends and family may comment and suggest there is something wrong. But some adults continue to be pigeon-toed without any real problems (indeed it's quite common for competitive sprinters to have pigeon toes).

See your general practice team or podiatrist if:

• only one foot and leg are affected
• your child's feet are stiff
• the problem is severe
• your school-aged tamaiti is regularly tripping and falling, which is stopping them from taking part in normal activities
• the problem continues past the age of 8.

These things may indicate that there is another problem, or your tamaiti needs some extra help.

Written by HealthInfo clinical advisers. Last reviewed May 2022.

Sources

Page reference: 351915

Review key: HICLF-132158