Intoeing In Children (Pigeon Toes) – Definition, Causes, Diagnosis, & Treatment 

In-toeing is a relatively common condition in infants and young children. In many cases, the cause of in-toeing is a congenital condition called Metatarsus Adductus, where the bones in the foot are turned inwards. In-toeing in babies can also be caused by other conditions, such as internal tibial torsion or femoral anteversion, which are related to the alignment of the leg bones. It usually resolves on its own as the child grows and develops. However, in some cases, in-toeing can be severe and may require treatment such as physical therapy, corrective shoes, or casting. 

I just recently learned that disorders of the lower leg are not uncommon in children after Lilly woke up from her afternoon nap with both her feet curved inward instead of pointing straight ahead.

And even though she showed no signs of pain or distress, the panic-stricken me couldn’t wait one more second. The news from the doctor was pleasant but very unexpected.

Honestly, I expected to hear that Lilly had a serious problem and that an X-ray would be our immediate next step before commencing the treatment.

But hearing the words that her condition, commonly known as in-toeing, is common and normal in growing children was equally a shocker.

According to the AAFP, in-toeing is one of the most common complaints from caregivers, coaches, and teachers about the appearance of the lower extremities in children.

Parents usually notice in-toeing when their child begins to walk; however, they may also notice it at various stages of development

Causes of in-toeing in babies

Intoeing, also known as “pigeon-toeing,” can be caused by a variety of factors, including:

1. Metatarsus Adductus 

Also known as “hooked it skew foot,” metatarsus adductus is a congenital foot deformity where the bones in the front part of the foot are turned inward, causing the foot to curve like a crescent moon.

According to the AAFP, this condition may occur at birth or during the first few months of a child’s life.

It usually resolves on its own by age four but, in some cases, may require treatment such as stretching exercises or casting. 

2. Internal tibial torsion 

This condition is a twisting of the shin bone, where the lower leg bone (tibia) is twisted, causing the foot to turn inwards.

The AAOS says that the internal tibial torsion condition usually resolves on its own by the age of 7, but some cases may require treatments that may include surgery. 

3. Femoral anteversion

Also known as the In-toeing gait, the thigh bone (femur) is twisted inward, causing the knees and feet to turn inwards when walking or running.

This thigh bone rotation is attributed to genetic factors or developmental issues during pregnancy.

Femoral anteversion resolves on its own by age 10, and only a few cases require physical therapy treatment or alignment with braces, according to the Children’s Hospital of Philadelphia. 

4. Abnormal muscle development

If the muscles in the legs or feet are weak or tight, it can cause the legs or feet to turn inward.

5. Injuries or fractures

If a bone in the leg or foot is injured or fractured, it can affect the alignment of the leg or foot and cause in-toeing.

6. Neurological conditions

Certain neurological conditions, such as cerebral palsy, can affect the muscles and nerves that control the legs and feet and cause in-toeing.

Diagnosis and assessment of in-toeing in children

If you suspect your child has in-toeing, it’s vital to have them evaluated by a medical professional.

The diagnosis is typically made through a physical examination and may involve X-rays or other imaging studies to determine the underlying cause.

Treatment, if needed, will depend on the underlying cause and severity of the in-toeing.

Treatment for in-toeing in babies

The treatment for in-toeing depends on the underlying cause of the condition. In many cases, in-toeing is a natural part of a child’s development and does not require treatment.

A foot doctor is checking a toddler patient on treatment options for her Intoeing condition

However, treatment may be necessary if the in-toeing is causing pain or affecting the child’s ability to walk or participate in physical activity.

If the in-toeing is caused by a condition such as a metatarsus adductus, internal tibial torsion, or femoral anteversion, treatment options may include:

  1. Observations and monitoring: In many cases, the in-toeing will improve as the child grows and develops. Your doctor may recommend monitoring the condition and waiting to see if it resolves.
  2. Physical therapy: If a tight muscle or tendon causes the in-toeing, stretching exercises may be recommended to help improve the alignment of the whole leg and the foot.
  3. Imaging techniques: If the physical observation and gait observation suggests an underlying bone deformity or a growth as the cause of the in-toeing, imaging techniques such as CT scans, MRI scans, or X-rays may be required. These imaging methods provide more details about the skeletal structure and help differentiate complicated cases from normal developmental variations.
  4. Orthotics and braces: Special shoes, braces, or other orthotic devices may be used to help correct the alignment of the foot.
  5. Surgery: In rare cases, surgery may be recommended to correct the alignment of the leg or foot.

It’s important to note that the treatment for in-toeing should be determined by a medical professional based on the condition’s underlying cause.

If you have concerns about in-toeing, it’s important to consult with a doctor or orthopedic specialist.


Is in-toeing a severe condition?

In most cases, in-toeing is not severe and will often resolve independently as a child grows.

However, in some cases, treatment may be necessary if the in-toeing is causing pain or affecting the child’s ability to walk or participate in physical activity.

Can in-toeing be prevented?

In many cases, in-toeing cannot be prevented, as it is often a natural part of a child’s development.

However, certain measures can be taken to promote healthy development, such as ensuring the child has proper footwear and encouraging physical activity.

Can in-toeing be corrected?

In many cases, in-toeing will improve as a child grows and develops. However, if treatment is necessary, options may include stretching exercises, special shoes or braces, or surgery in rare cases.

When should I be concerned about in-toeing?

If the in-toeing is causing pain or affecting the child’s ability to walk or participate in physical activity, it is important to consult a doctor or orthopedic specialist.

Additionally, if the in-toeing is severe, does not improve with time, or is accompanied by other symptoms, such as limping or difficulty walking, it is important to seek medical attention.

Is in-toeing hereditary?

In some cases, in-toeing may be hereditary, but other factors, such as abnormal muscle development or injuries, can also cause it.


The long-term prognosis for children with in-toeing is positive. Parents and caregivers should take comfort in experts’ consensus that most cases of in-toeing resolve with time without intervention. 

If you’d like to learn more about your baby’s lower extremities’ growth and development, see the post below


Was this article helpful?

Hello, I am Emelda from Nairobi, Kenya. They simply call me mama Lilly. A fun of long road trips and a very good cook, along with my mommy duties to a super active girl. She inspires and challenges me in equal measure, and that is how I get to share with you our journey of triumph as we grow and tag you along.

Leave a Comment