Intoeing…should I be worried if my child is “pigeon-toed?”

Intoeing is a description of how someone’s feet point relative to the frame of the body as she walks. Some people in-toe a bit, some out-toe a bit. Very few people walk forward with their toes pointed in a totally straight line. Most forms of intoeing are harmless or “within the bell curve” of what is normal for the alignment of our lower limbs.


What causes intoeing? You may be surprised to learn that much intoeing starts above foot level! Our bones are not perfectly straight cylinders, like soda straws. If you’ve ever paid attention to a chicken drumstick, you may have noticed the bone is not straight end to end.




A child’s thigh bones (femur) or shin bones (tibia) might have more curve built in and, causing the feet to be directed inward.  In such a case, the feet themselves may be relatively straight.  Beyond the contour of the bones, the tension between our feet bones and the associated muscles and tendons may promote intoeing.


When the femur or thigh bone directs most of the intoeing, it is called femoral anteversion. Many kids with femoral anteversion are “W” sitters, because it is more comfortable than sitting “criss-crossed.” W sitting is not considered problematic by Pediatric Orthopedic doctors.

If the tibia or shin bone is responsible it is called tibial inward torsion.


When the foot itself is the main driver of the intoeing it is usually called metatarsus adductus.


If your youngster intoes, relax! Most intoeing does not require bracing, and even fewer require surgery. In the majority of cases, your pediatric orthopedic doctor will assure you that intoeing is a normal part of your individual child’s anatomy and development.  As kids get older, most either develop healthy adaptations to intoeing. Intoeing can even promote faster running in some individuals. Many soccer forwards and football running backs are pigeon-toed.  If that describes your child, maybe you’ve got an athletic star on your hands!