• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

Pigeon Toes: Causes and Treatment

A pigeon toe is a medical condition in which the toes of person, most commonly a child, turn in while walking or running. The painless condition is also known as in-toeing and is most often seen in children up to the age of 8 years. However, most children grow out if before reaching their teen years. In very rare cases, treatment or surgery is required. Pigeon toes can occur in one or both feet and most often develop due to genetic anomalies or even in the womb.

Causes of Pigeon Toes

Metatarsus Adductus: For many children, pigeon toes develop in the womb itself due to limited space in the womb because of which the front portion of the feet turns inward. This can also happen if the child was facing in the wrong direction in the womb or if the mother had low levels of amniotic fluid. This particular condition, where the toes grow inward in the womb is known as metatarsus adductus. In this, the front foot is angled in towards the middle, while the rest of the foot and ankle are normal. The problem often resolves itself as the child gets older. Also, the parents can gently stretch the foot of the child to correct its shape.

Tibial Torsion: In other cases, some children while growing their legs during the toddler years encounter this problem. This in-toeing may be a result of twisting of the tibia or the shinbone. The condition is medically known as tibial torsion. It is not noticeable in initially but becomes evident when the child begins to walk. This condition is not painful; however, can cause the child to fall several times, thus increasing chances of injury. Tibial torsion often treats itself with time without any treatment. However, if the problem does not resolve by the age of 9 or 10 years, internal tibial torsion might require surgery, which will involve cutting through and reattaching the twisted bone to the make the foot straight.

Femoral Anteversion: For the rest, children who are aged 3 years or above, pigeon toes can develop as a result of turning-in of the femur or the thighbone. This condition is called medial femoral torsion or femoral anteversion. Girls have a high risk of contracting the problem as compared to boys. This is the most common type of pigeon toes that occurs in children and is most commonly caused due to the stress in the hips before birth; however, the exact cause is not known.

Symptoms of Pigeon Toes

The symptoms of pigeon toes depend on the type of or cause of the problem; such as in metatarsus adductus, the symptoms are easily noticeable at birth and soon afterwards. One or both the feet will be turned inward, even while resting, while the outer edge of the foot is crescent curved.

On the contrary, internal tibial torsion is not so evident and only becomes fairly obvious when the child starts walking. Both or one of the feet of the child will turn inward with each step while walking.

As for medial femoral torsion, the condition may become noticeable after the age of 3 years, while major symptoms are present between 5-6 years of age. In most cases, a child suffering from a medial femoral torsion will turn the foot and knee both in while walking. It will also happen when the child is standing in one place. A major noticeable symptom of this condition is that the child will sit with legs flat on the floor and feet out either side forming a ‘W’-like shape.

Risk Factors of Pigeon Toes

All three causes of pigeon toes occur because of family history. Most often children, whose parents or grandparents have or had pigeon toes issues, may get this as a genetic tendency. In other cases, pigeon toes can be due to do development conditions which affect the feet or legs.

Diagnosis of Pigeon Toes

Intoeing caused due to pigeon toes can be barely visible or could be extremely prominent to affect the child’s gait. To diagnose the condition, the doctor will observe the child perform functions such as standing and walking. They also tend to move the child’s feet to feel how the knees bend and then look for symptoms that indicate the presence of twisting or turning in the child’s hips.

Post the physical examination, the doctor will conduct X-rays and CT scans to check the alignment of the bones internally. A special X-ray video called fluoroscopy can be used to check the bone in the child’s legs while in motion.

The exact cause of the problem may be identified based on family history and medical tests.

Treatment of Pigeon Toes

For cases, where the child experienced mild or moderate in-toeing, the problem tends to outgrow itself without any treatment. However, the outgrowing can be long and could take years but it does allow the bones to settle into the right alignment on their own.

However, for infants who have serious metatarsus adductus, a series of casts may be placed on the affected foot or feet for some weeks. The casts are only placed when the infant is at least 6 months older and are placed to correct the alignment before the child starts walking. Along with the casts, the doctor might suggest some stretches and massages help the child’ bones grow in the right direction.

For tibial torsion and medial femoral torsion, the child will not need any casts, braces or special shoes. These types of pigeon toes tend to automatically resolve with time. In case, the condition does not improve by the time the child reaches the age of 9 or 10 years, surgery may be recommended to align the bones properly.

Overall, pigeon toes are often a painless condition, which tends to resolve on their own and do not cause any health complications. But parents must consult a doctor early on and seek treatment if the problem does not resolve with the expected time.

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