Pigeon Toes – In-toeing

Intoeing (also known as pigeon toes) is when the feet turn inwards (adducted angle of gait) when walking. It is a common concern in childhood. Intoeing may be due to a single cause or multiple factors. The main causes of in-toeing gait are associated with different developmental patterns at different ages (Jacobs, 2010).

1-2 year old: metatarsus adductus
2-3 year old: internal tibial torsion
Over 3 years: femoral torsion
If intoeing gait is not developmental it is important to consider familial, neurological and orthopaedic involvement. A very common differential diagnosis is cerebral palsy as intoeing gait is a frequent problem in children with cerebral palsy (Evans, 2010).

Signs and symptoms

Most children grow out of it by the ages of 8-10. The child typically presents with:

The foot adducted with a narrow base of gait.
Feet turn inwards
Feet shaped like a crescent moon (usually in infants)
Shin or thighbone that turn inward
Limping, tripping
Pain (some patients)