Learn what pigeon toes are in children, common causes, when it's normal, signs to watch for, treatment options and when to seek professional help.
If you've noticed your child's feet turning inward when they walk or run, you're not alone. While it can look unusual, the good news is that in-toeing is often a normal part of childhood development and usually resolves on its own without treatment.
Pigeon toes refers to a gait pattern where one or both feet angle inward instead of pointing straight ahead. You might notice it most clearly when your child walks across the room or runs during play. Unlike the typical toddler waddle, which is wide-based and outward-turning, in-toeing creates a distinctive appearance where the toes point toward each other.
In-toeing can appear at different stages of childhood, from infancy through early elementary school years. The timing often depends on which part of the leg is causing the inward rotation. Most cases are developmental, meaning they're related to normal growth patterns as bones, muscles, and joints mature. Understanding where the rotation originates helps us determine whether observation or intervention is needed.
Pigeon toes often appear during early childhood and are usually part of normal growth and development. Understanding when pigeon toes commonly appear can reassure parents and help them know what changes to watch for.
In babies, pigeon toes are often noticeable when the front of the foot curves inward. This is commonly due to positioning in the womb and is known as metatarsus adductus. In most cases, the foot is flexible and gradually straightens as the baby grows, begins to bear weight, and starts walking. Many infants outgrow this naturally within the first year or two of life.
Pigeon toes are frequently seen in toddlers who are just learning to walk. At this stage, the most common cause is internal tibial torsion, where the shin bone rotates inward. As toddlers gain strength, coordination, and muscle control, their walking pattern often improves on its own. This type of in-toeing typically becomes less noticeable between ages 2 and 4.
In early childhood, pigeon toes may be related to femoral anteversion, a natural inward rotation of the thigh bone. Children with this condition may prefer sitting in a “W” position and may walk or run with their feet turned inward. While it can look concerning, femoral anteversion usually improves as bones continue to grow and align, often resolving by ages 8 to 10.
Children’s bones are still forming and reshaping as they grow. Many cases of pigeon toes reflect normal variations in bone alignment that correct themselves over time. When in-toeing is painless, symmetrical, and doesn’t interfere with walking or play, it’s typically considered a normal developmental phase. Monitoring growth and movement patterns is often all that’s needed, though professional evaluation can provide peace of mind if concerns arise.
There are three primary anatomical causes of pigeon toes in children, each affecting a different part of the leg and appearing at different ages. Identifying which type your child has helps us predict the natural course and determine the best approach to care.
Metatarsus adductus is the most common cause in infants and involves a C-shaped curve in the forefoot, where the front part of the foot bends inward while the heel remains in a normal position. This condition often results from the baby's position in the womb and is typically noticed at birth or within the first few months of life.
The majority of cases are flexible, meaning the foot can be gently straightened with your hand, and these tend to resolve naturally as the child begins to stand and walk. More rigid cases may require stretching exercises or, occasionally, serial casting.
Internal tibial torsion affects the shinbone (tibia) and is most commonly seen in toddlers between the ages of one and three. With this condition, the entire lower leg rotates inward from the knee down, causing both the foot and knee to point toward the midline when walking.
This inward twist of the tibia is often related to the position babies hold while sitting or sleeping. The good news is that as children grow and become more active, the bone gradually rotates outward naturally, and in most cases is fully corrected by age four or five without any treatment.
Femoral anteversion involves an inward rotation of the thighbone (femur) and typically becomes noticeable in children between ages three and eight. When the femur rotates inward at the hip, it causes the entire leg to turn in, making the knees and feet point toward each other.
Children with femoral anteversion often prefer to sit in a 'W' position with their legs splayed out to the sides, which feels more comfortable because of their hip anatomy. This is the most common cause of in-toeing in school-age children. While it can persist longer than the other types, femoral anteversion usually improves significantly by adolescence as the bones continue to develop and remodel.
For most children, in-toeing is a normal developmental variation that improves naturally with growth and increased activity. If your child is pain-free, active, able to run and play without limitation, and showing gradual improvement over time, observation is typically all that's needed. Symmetrical in-toeing, where both feet turn in equally, is also generally reassuring and suggests a developmental pattern rather than an injury or structural problem.
However, certain signs warrant a professional evaluation. Schedule an appointment with a podiatrist if your child experiences pain with walking or running, as discomfort is not a normal feature of developmental in-toeing.
Frequent tripping or falling beyond what's typical for their age, or asymmetry where one foot turns in significantly more than the other, should also be assessed. Other red flags include uneven wear patterns on shoes, with one side wearing down much faster than the other, or in-toeing that persists or worsens after age eight to ten.
If your child has difficulty participating in physical activities they enjoy, such as sports or playground games, or if you notice they avoid activities because of their gait, it's time to seek expert guidance. We also recommend evaluation if your child's in-toeing is accompanied by other concerns, such as leg-length differences, muscle weakness, or if you're simply worried and want professional reassurance. At Sweeney Foot & Ankle, we believe parent intuition matters, and we're here to provide the clarity and peace of mind you need.
The good news is that most children with pigeon toes don't need aggressive treatment. Our approach at Sweeney Foot & Ankle follows a conservative, evidence-based philosophy, starting with the least invasive options and progressing only if necessary.
In most cases, observation and growth monitoring are the appropriate first step. We'll schedule regular follow-up appointments to track your child's development and ensure the in-toeing is improving naturally over time. During this period, we encourage normal activity and play, which actually helps with bone remodeling and muscle development.
For certain types of in-toeing, particularly flexible metatarsus adductus, we may teach you gentle stretching exercises to perform at home. These stretches help guide the foot into better alignment as your child grows. We'll demonstrate the proper technique and frequency to ensure you feel confident helping your child at home. Stretching is most effective when started early and done consistently, but should never cause pain or distress.
Custom orthotics or shoe modifications may be recommended if your child has significant foot positioning issues, discomfort, or if the in-toeing is affecting their ability to participate in activities. Unlike generic over-the-counter inserts, our custom orthotics are designed specifically for your child's unique biomechanics and can help redistribute pressure, improve alignment, and support proper development. We'll take precise measurements and create a personalized treatment plan, including follow-up adjustments as your child grows.
In rare cases of rigid metatarsus adductus that don't respond to stretching, serial casting may be necessary. This involves applying a series of casts over several weeks to gradually guide the foot into proper alignment. While this sounds intensive, it's very effective for the small percentage of children who need it, and most kids adapt quickly to the process.
At home, there are several things you can do to support your child's foot development. Encourage barefoot play on safe surfaces like grass or carpet, which allows the feet to develop natural strength and flexibility. Avoid purchasing 'corrective' shoes or devices marketed in stores without professional guidance, as these are often unnecessary and not evidence-based. Instead, focus on well-fitting shoes with adequate room for growth and proper support.
Monitor your child's walking patterns and activity levels, and keep a simple log if you notice changes or have concerns to share at your next appointment. Most importantly, maintain a positive, encouraging attitude. Developmental in-toeing doesn't define your child, and with patience and appropriate guidance, the vast majority of children go on to enjoy completely normal, active lives.
Pigeon toes are common in children and, in many cases, are a normal part of growth that improves over time. However, if your child experiences pain, frequent tripping, or in-toeing that doesn’t seem to improve with age, a professional evaluation can provide clarity and peace of mind.
If you have concerns about your child’s walking or foot development, the team at Sweeney Foot & Ankle is here to help. Schedule an appointment today to ensure your child is on the right path for healthy movement and development.