Intoeing

Intoeing or Pigeon-toe’d is a reasonably common condition. Intoeing can cause clumsiness, tripping and falling. It can also cause leg and foot pain often dismissed as “growing pains.”

In our first 6 years of life, our leg bones undergo a series of rotational changes. We start off with our legs rotated inwards making it look like this:

Our legs then continue to de-rotate as we pass developmental milestones such as crawling and progressing to standing and walking. By the time we reach 2 and a half the leg should look something like this, reasonably straight with a mild flat arch:

At the age of six the legs resemble the child’s adult legs and not much rotational changes occur after that.

There are cases in which the de-rotation of the leg bones are delayed and this results in intoeing.

The legs will look like picture A if the femur (thigh bone) is the problem and like picture B if the tibia (long bone below knee) is the problem. The difference is in the angle of the knee. Picture A the knees point inwards and in picture B the knees point forward while the feet are intoeing.

What causes the delay in de-rotation? There are a few causes but by far the most common would be when the child adopts sleeping and sitting habits such as this:

These sitting and sleeping postures prevent the leg bones from attaining there correct alignment and forcefully keep them internally rotated.

Between the age of 2 – 4 a certain degree of intoeing is normal. If the intoeing causes symptoms and is more than expected for that age then treatment is considered.

Treatment using custom made orthotics known as gait plates and exercises are very effective when prescribed by a podiatrist with sufficient experience in paediatrics. The child should be monitored every few months for signs of improvement and to ensure no secondary problems from the intoeing occurs. Children who are intoeing may also have other underlying leg and foot problems that may require treatment too.

The good news is that with early detection and treatment the problem can be solved.