Pigeon toe

Pigeon toe, also known as in-toeing, is a condition which causes the toes to point inward when walking. It is most common in infants and children under two years of age and, when not the result of simple muscle weakness, normally arises from underlying conditions, such as a twisted shin bone or an excessive anteversion (femoral head is more than 15° from the angle of torsion) resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.

Causes

The cause of in-toeing can be differentiated based on the location of the misalignment. The variants are:

Curved foot (metatarsus adductus)

Twisted shin (tibial torsion)

Twisted thighbone (femoral anteversion)

Metatarsus adductus

This is the most common form of being pigeon toed, when the feet bend inward from the middle part of the foot to the toes. This is the most common congenital foot abnormality, occurring every 1 in 5,000 births. The rate of metatarsus adductus is higher in twin pregnancies and preterm deliveries. Most often self-resolves by one year of age and 90% of cases will resolve spontaneously (without treatment) by age 4.

Signs and Symptoms

C-shaped lateral border of foot

Intoeing gait

Pressure sites during shoe wear

Tibial torsion

The tibia or lower leg slightly or severely twists inward when walking or standing. Usually seen in 1-3 year olds, internal tibial torsion is the most common cause of intoeing in toddlers. It is usually bilateral (both legs) condition that typically self-resolves by 4 to 5 years of age.