Intoed Gait (Pigeon Toe)
What is intoed gait?
Often parents will bring their children into the clinic concerned that their child is intoed or ‘pigeon toed’. Intoeing is commonly seen in young children and, in the majority of cases, will resolve without requiring any treatment (think about how many intoed children you see compared to adults!).
Intoed gait is referred to when feet are turned inwards instead of slightly outwards. There is no evidence that intoe gait causes problems in the future. Intoe itself does not cause the child to develop pain. Most children manage their intoe very well. In some more obvious cases though it can cause the child to be clumsy and trip over their feet.
What causes intoed gait?
More insidious causes of intoeing should be ruled out and may include cerebral palsy and hip dysplasia.
In healthy children, the three most common causes of intoeing come from either the level of the foot, leg or hip:
- Metatarsus Adductus – most common cause in an infant. The forefoot is twisted inward compared to the rearfoot, resembling the shape of a banana. This is thought to occur while the baby is all curled in the mother’s womb. Metatarsus adductus often resolves spontaneously after birth. Sometimes soft tissue massage and stretching or splinting is required to straighten the foot.
- Internal Tibial Torsion – increased twist of the tibia causing intoed appearance. Most common between ages one and two, and spontaneously resolves.
- Excessive Femoral Anteversion – internal position of the hip (internal >>> external range of motion of hip, should be equal). The knees point in towards each other (squinty patella). Causes intoeing at age 3-4 years and deformity may increase up to 5-6 years then decrease gradually. If due to a spongy (muscular) restriction vs bony restriction, lots of internal hip rotator / hamstring / hip capsule stretches and glute strengthening exercises can be beneficial.
How is this condition treated?
Treatment for intoe gait depends on whether the cause is at the level of foot, leg or hip and whether it is affecting the child’s coordination. Generally, no treatment is necessary as the intoe often resolves or greatly improves with development. In some cases, stretching and strengthening exercises, specific footwear, or bracing and gait plates may be necessary.