A foot turning inward, medically referred to as in-toeing or “pigeon-toed,” describes a condition where one or both feet point toward the midline of the body instead of straight ahead during standing or walking. This alignment can be observed at various points along the leg, from the foot itself to the shin bone or the thigh bone. While often a temporary and normal part of development in children, in-toeing can also occur in adults, sometimes indicating an underlying issue.
Common Causes in Children
In-toeing is a common observation in children, often linked to normal developmental variations as they grow. The three primary causes stem from different parts of the leg: the foot, the shin bone, or the thigh bone.
Metatarsus adductus is a foot deformity present at birth where the front part of the foot curves inward, giving it a “C” shape. This condition is thought to be related to the baby’s position in the uterus, and it is the most common cause of in-toeing in infants. Most cases resolve without intervention, often by the time a child is six months to two years old.
Tibial torsion involves an inward twist of the shin bone, or tibia. This twisting can occur before birth due to the limited space in the womb. Internal tibial torsion typically becomes noticeable when a child begins walking, usually between two and four years of age, and commonly corrects itself as the child grows, often by school age or around five to eight years old.
Femoral anteversion is characterized by an inward twist of the thigh bone, or femur, at the hip. This condition causes both the knees and feet to point inward. It is often most apparent in children between the ages of two and four, and the inward rotation tends to increase around this time, becoming most obvious between five and six years of age. The vast majority of cases of femoral anteversion also resolve naturally as the child matures, usually by nine or ten years of age.
Common Causes in Adults
While less common than in children, in-toeing can persist or develop in adulthood, often due to different factors than those seen in younger individuals. Adult in-toeing typically does not resolve without intervention.
Neurological conditions can significantly affect muscle control and coordination, leading to in-toeing. Conditions such as cerebral palsy, stroke, or nerve damage can disrupt the signals between the brain and muscles, causing the foot or leg to turn inward. This impact on muscle tone and motor control can result in in-toeing as a compensatory mechanism.
Structural issues within the foot, ankle, knee, or hip can also contribute to in-toeing in adults. Severe arthritis, for example, can alter joint alignment and mechanics. Previous injuries that did not heal correctly, such as improperly set fractures of the tibia or femur, can also cause in-toeing.
Sometimes, the foot turns inward as a compensatory mechanism to address other gait abnormalities or pain in the leg or hip. Individuals may adopt this pattern to alleviate discomfort, improve balance, or adjust for muscle imbalances like weakness or tightness in certain leg or hip muscles. Weak arches or flat feet can also cause the toes to rotate inward for comfort or stability.
When to Seek Medical Attention
While in-toeing in children often corrects itself, certain signs indicate that medical evaluation is beneficial. If a child experiences pain or discomfort associated with their in-toeing, or if they develop a limp or difficulty walking, consult a doctor.
If the condition appears to be worsening over time, especially in children past toddlerhood, seek medical attention. If one foot turns inward significantly more than the other, or if a child frequently trips or falls, consult a doctor. For adults, any sudden onset of in-toeing could signal an underlying neurological or structural problem. If the in-toeing has not resolved on its own by a certain age, such as eight to ten years old in children, professional guidance may be necessary.
Diagnosis and Treatment Approaches
Diagnosing in-toeing typically involves a thorough physical examination where a medical professional observes the individual’s gait and assesses the angles of their feet, ankles, knees, and hips. Imaging studies, such as X-rays, are usually not necessary unless there are concerns about structural issues or if symptoms persist despite observation.
Treatment approaches for in-toeing vary considerably depending on the individual’s age, the underlying cause, and the severity of the condition. For most mild cases in children, observation is the most common approach, as many resolve naturally with growth. Medical professionals often advise parents that special shoes, braces, or exercises typically do not hasten this natural correction.
When intervention is needed, physical therapy can be beneficial, particularly for addressing muscle imbalances, improving flexibility, and guiding proper gait patterns. Bracing or orthotics, such as custom shoe inserts, may be considered to help guide foot development or support proper alignment, especially for more severe cases of metatarsus adductus in infants or to manage symptoms in adults. Surgical intervention is rare and generally reserved for severe cases that cause pain, significant functional impairment, or fail to respond to other treatments. These procedures involve realigning bones, but they are considered only when other, less invasive methods have not been effective.