WHAT YOU NEED TO KNOW: What is intoeing? Intoeing means your child walks with his toes pointed in. It is also called pigeon toe. One or both of your child's feet may be affected. Your child may start to show signs of intoeing any time up to about 8 years of age. Intoeing is common in children. It can be mild or severe and often goes away without treatment. What causes intoeing? Many types of intoeing are genetic (passed from parent to child). The following are common conditions that can lead to intoeing: - Feet in a curled position while in the womb
- A twisted shinbone or thighbone
- A muscle imbalance or nerve problem, such as cerebral palsy
- Hip dysplasia (dislocated hip joint)
- A condition called clubfoot that causes the foot to turn inward
What are the signs of intoeing? The signs will depend on what is causing the intoeing. - A deep crease in your infant's foot that is rigid or hard to straighten, and a sharply curved outer foot
- Feet that turn inward when your child walks or runs
- A knee that points inward, and a turned in hip
- Bowed legs
- A big toe that points away from the toe next to it
- Sitting with bottom and thighs on the floor, knees bent, and feet behind (called W-sitting because the legs form a large W)
- Problems walking, such as tripping often
How is the cause of intoeing diagnosed? Your child's healthcare provider will ask when your child's intoeing started and if it is getting worse. Tell him if you notice any serious problems your child has walking or running. Tell him if anyone in your child's family has intoeing or if you had any problems during pregnancy or delivery. He may also ask when your older child started walking. X-rays and similar tests are usually not needed unless the intoeing is severe or other problems are found. Your child's healthcare provider may use any of the following to find the cause and to plan treatment: - A physical exam is used to examine your child's feet, legs, and hips. Your child's healthcare provider may have your child lie on his stomach with his knees bent. This allows him to see if the foot is lined up with the thigh. He will also be able to see if your child's toes point inward. He may also measure how far your child's hip joints can rotate. He will move your child's legs in different directions when he is on his back and on his stomach.
- A walking test can help him see how your child's feet and legs point as he walks. He will also look to see if your child's legs are bowed.
- A sitting test will help him see if your child sits in the W pattern. Children with a twisted thighbone prefer to sit in this position because it is more comfortable for them.
How is intoeing treated? Your child may need treatment if his foot position does not straighten on its own. He may also need treatment if his intoeing is caused by a problem such as cerebral palsy or clubfoot. Most intoeing treatment is meant for babies who have not started to walk. Your healthcare provider can tell you if your toddler or older child needs treatment. - Stretches may help your infant's foot straighten. Your child's healthcare provider will tell you if he thinks the stretches might help. They do not work for every infant. If he does recommend the stretches, he will show you how to do them.
- Casts or braces may be used to help move your child's feet to the correct position. His healthcare provider will apply a cast or brace and leave it in place for a time. He will then remove it and move the foot closer to the correct position. Then he will apply a new cast or brace. This will continue for up to 6 months. Your child's healthcare provider may wait until your child is 4 to 6 months old before starting. This is to make sure the intoeing is not going to go away on its own. The goal is to have the intoeing corrected before your child starts walking.
- Surgery is only used for severe forms of intoeing that are not corrected with other treatment. Healthcare providers wait until the child is 9 or 10 years old to do surgery, to be sure it is necessary.
What can I do to help manage my child's intoeing? - Do not use any corrective devices unless directed. Shoe inserts and cables do not help fix the problem. They can also make it hard for your child to play and walk.
- Ask about your child's activities. Ask if your older child can do activities such as sports. He may need to wait if intoeing causes him to trip.
When should I contact my child's healthcare provider? - Your child develops a limp when he walks.
- Your child has leg pain or swelling.
- You have questions or concerns about your child's condition or care.
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