If your child is in their early stages of walking, do their feet point inwards when they walk? Do they trip over their own feet sometimes? These are some signs of in-toeing, which is more commonly called “pigeon toed.” Do you need to be concerned?
For a short period of time, this in-toeing may be a normal part of development and will most likely fix itself before the child turns 3 years old. However, not all children will stop in-toeing with out podiatric intervention.
In-toeing is caused by 3 different bone mal-alignment deformities, which include the following:
- Metatarsus adductus: This is a deformity of the foot. The foot bones are slanted inwards and the foot looks like a C. In addition, there may be what is called congenital hallux varus. Congenital hallux varus occurs in 2% of patients and it is a deformity in which the big toe points to the inside.
- Internal femoral anteversion: This is a deformity of the femur, which is the long bone of the thigh. The femur in this deformity is twisted/rotated inwards and fails to rotate outwards.
- Internal tibial torsion: This is a deformity of the tibia, which is the larger of the two bones in the leg, which is between the ankle to the knee. This deformity is similar to femoral anteversion, because the tibia is also twisted/rotated to the inside.
These mal-alignment deformities are usually due to the child being crowded while in the womb. The most common of the three deformities for the underlying cause of in-toeing is internal tibial torsion. Internal tibial torsion affects both males and females equally. However, it usually causes the left foot to be more in-toed than the right foot. This is similar to metatarsus adductus in that the left foot is more affected, but it is more common in females than males. Lastly, internal femoral anteversion affects females more than males, usually affects both feet, and this is possibly an inherited deformity.
So how do these deformities cause in-toeing, especially internal femoral anteversion and internal tibial torsion since those are not foot deformities? In order for the foot to be in proper alignment with the foot pointing forward, the entire lower limb needs to be in proper alignment. If the femur and/or tibia are twisted/rotated inwards, the foot will need to follow to match-up with the other bones.
There are only a small percentage of children whose in-toeing does not correct with time. If this is the case, a podiatrist can help treat the child by fixing the limb to be in appropriate alignment. Treatment includes fixing the underlying cause. There are various treatments for metatarsus adductus, internal femoral anteversion, and internal tibial torsion. Some of the treatments may include:
- Stretching and strengthening exercises
- Various types of braces, splints, and casts
- Specialized shoes
- Numerous surgical procedures
The type of treatment will be based on further evaluation of the underlying cause of the in-toeing, severity of in-toeing, and age of the patient. Orthotics, or an arch support is typically the first line of treatment depending on age. If you are concerned about your child’s in-toeing, it is best to visit Platte Valley Foot and Ankle Clinic sooner than later, to prevent the deformity from worsening, so more non-surgical treatments may be an option.