In-toed Gait (Pigeon Toed) - Causes and Treatment

 

What is intoed (or in toed or intoeing) gait?

An intoed gait (where the toes point inwards) when walking and running is quite common in children. In some cases this is part of normal development and other times not. A common side effect of intoed gait is increased tripping and falling (sometimes worse when running or playing sport). It is not usually painful.

 

In Toed Gait

How common is it?

Studies have shown that at 1 in 10 (or more) children have intoed gait. Intoed gait is quite common up to the age of 6 years, and then tends to reduct with increasing aga, so the good news is that many people grow out of it during childhood.

What causes it?

Intoed gait can arise from a single cause or multiple causes, and the primary causes of intoed gait are usually caused by different things at different age groups, as follows:

  • Infants (1-2 years): metatarsus adductus (when the front part of the foot bends towads the midline between the two feet
  • Toddlers (2-3 years): internal tibial torsion (when the shin bone twists towards the mid
  • Childnren (over 3 years): femoral torsion (a twisting of the thigh bone)

Sometimes, there is no deformity and the cause can be related to tight muscles. In all cases a thorough assessment is warranted in order to exclude other conditions.

Diagnosis

In order to come up with a diagnosis, your podiatrist may ask questions about the child's birth, growth and development, as well as conducting a physical examination and assessment of gait. At the Perth Foot & Ankle Clinic we also have a Bodytech treadmill and gait analysis machine, which is not only helpful in diagnosis, but is also a valuable tool to help monitor a child's development over time.

  • Often the cause of intoed gait is developmental (i.e. part of growing up) and it will resolve over time.
  • Intoed gait can run in families, so it can be more likely if siblings or parents have had the same problem.
  • Some neurological problems can cause intoed gait
  • Some other orthopaedic problems can cause changes in the hips, legs or feet which can lead to intoed gait.

Treatment

Treatment depends upon the diagnosis, and may include the following:

  • Monitoring and observation (in other words, no treatment)
  • Changes in sitting/sleeping postures
  • Stretches and exercises (usually in the form of games in younger children)
  • Different shoe choices
  • Special orthotics called gait plates, that encourage the foot to work in a more straight position and minimise tripping/falling
  • Splintng and/or casting
  • Surgery is not commonly indicated

The material contained in this article was adapted from The Pocket Podiatry Guide: Paediatrics by Angela Evans (Churchill Livingstone, 2010).

Image credit: orthoinfo-hkcos.org

Andrew Schox
Andrew joined the practice in 1997 and practices in all areas of podiatry.