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Starship Paediatric Orthopaedics

Public Service, Paediatrics, Orthopaedics


Intoeing (pigeon toed) is common in children and is often considered a normal part of development. Your child's gait pattern will improve over time without the need for treatment. Most children that intoe stop doing so by the age of 8 to 10 years. It is extremely rare to operate on this condition.


What is intoeing? 


Intoeing develops from one of three areas: the foot, the knee, or the hip:


  • Foot (metatarsus adductus). This is the most common cause of intoeing from birth to two years of age. It is believed to be caused by the positioning of the baby's foot in the uterus or from family history. If the foot is flexible and can be gently pulled into the correct position, no treatment is necessary. If the foot is rigid, and your child is under eight months of age, your doctor may recommend casting


  • Knee (tibial torsion). This is usually noticed during the second year of life after the child has started walking. The shinbone (tibia) is slightly twisted or rotated causing the foot to turn inward. This may be caused by the positioning of the baby's foot in the uterus or from family history. It is also related to bow legs and gets better as the bow legs improve with growth


  • Hip (femoral anteversion). Children between the ages of three and seven may walk with their kneecaps pointing inward. This is caused by a slight rotation of the top of the hip bone (femur) in the socket of the hip. This is very common especially in girls aged between 3 and 7 years.


Out-toeing usually occurs during the first year of life. It is due to the position of the hips within the uterus and will resolve without treatment.


What is the treatment for intoeing?


The best treatment is observation. You can take pictures each year of your children standing and then compare the progression of the straightening process. In very rare instances a bone cutting operation to correct rotation can be done after the age of 12-14 years if at that stage the child is close to fully grown, intoeing is still severe and has still not resolved.

Facts about intoeing

  • Intoeing is common in children
  • There are no braces, cables or orthotics that will make the slightest bit of difference.  Many years ago these were used but it has been proved that they are NOT effective 
  • Falling is part of learning to walk and is not exclusively caused by intoeing
  • Intoeing will not affect your child's ability to walk, or run or play even if it persists into adulthood.

This page was last updated at 10:03AM on September 29, 2021.