Pigeon Toeing (In-Toeing) in Children: Expert Insights from Bankstown Podiatry and Injury Clinic

As parents, we constantly observe and marvel at the developmental milestones our children achieve. From their first steps to their first words, every achievement is a cause for celebration. However, sometimes we may notice certain foot positioning abnormalities in our children, such as pigeon-toed walking or in-toeing. If you’ve ever noticed your child walking with their toes pointed inward, you may be curious about what causes this condition and whether it’s a cause for concern. In this blog, Dr Bilal Khelladi from the Bankstown Podiatry and Injury Clinic aims to shed light on pigeon-toeing in children, providing expert insights and guidance on how to address and manage this condition.

What is Pigeon Toeing (In-Toeing)?

Pigeon-toeing, medically known as in-toeing, is a common condition where a child’s feet turn inward instead of pointing straight ahead while walking or running. This condition may affect one or both feet, and it can be observed from an early age. As children grow and become more active, pigeon-toeing can become more noticeable.

Causes of Pigeon Toeing in Children

Several factors can contribute to the development of pigeon toeing in children, and it’s essential to understand them to address the issue effectively. Here are the primary causes:

  1. Femoral Anteversion: This is the most common cause of in-toeing and is related to the position of the hip joint. In children with femoral anteversion, the thigh bone (femur) is twisted inward, causing the feet to turn inward as well.
  2. Internal Tibial Torsion: Another common cause, internal tibial torsion, is related to the shin bone (tibia). The tibia may be twisted slightly inward, leading to in-toeing during walking.
  3. Metatarsus Adductus: This condition involves a curvature of the foot, causing the front part of the foot to turn inward. It can contribute to pigeon-toeing in some cases.
  4. Muscle Imbalance: In rare instances, muscle imbalances in the legs can lead to in-toeing.
  5. Genetics: Pigeon toeing can sometimes be hereditary, running in families

When to Seek Professional Help

In many cases, pigeon toeing resolves on its own as children grow and develop. However, it’s crucial to monitor the condition closely and seek professional help if:

  • The in-toeing is severe or worsening over time.
  • Your child complains of pain or discomfort.
  • One foot is significantly more turned inward than the other.
  • The in-toeing persists beyond the age of 8 years.

Expert Advice from Bankstown Podiatry and Injury Clinic

At Bankstown Podiatry and Injury Clinic, our experienced podiatrist Dr Bilal Khelladi, emphasize the importance of early detection and intervention when it comes to pigeon-toeing in children. Timely assessment and appropriate management can help prevent long term potential complications and ensure your child’s healthy foot development.

How do we assess Pigeon Toeing (In-toeing) at the Bankstown Podiatry and Injury Clinic?

  1. Medical History: We will discuss your child’s birth history, milestones, and any family history of foot or gait abnormalities.
  2. Physical Examination: Dr Bilal Khelladi will conduct an advanced biomechanical assessment where he will observe your child’s gait, leg and foot alignment, and joint mobility.
  3. Range of Motion Tests: We will assess the flexibility and rotation of the hips, knees, and ankles to determine the underlying cause of in-toeing.
  4. Imaging Studies: In some cases, X-rays may be ordered to get a more detailed view of the bones and joints.

How to treat Pigeon Toeing (In-toeing) in children?

The treatment approach for pigeon toeing depends on the underlying cause and the severity of the condition. In most cases, conservative treatments are effective and may include:

  1. Watchful Waiting: In mild cases of in-toeing, no active treatment may be required, and close monitoring is sufficient as the child grows.
  2. Stretching Exercises: Our podiatrist may recommend stretching exercises to improve muscle flexibility and correct mild cases of in-toeing.
  3. Orthotic Devices: Custom-made orthotics can help support the foot and correct alignment issues in some cases.
  4. Corrective Footwear: Special shoes or shoe inserts may be prescribed to promote proper foot positioning during walking and running.
  5. Bracing or Casting: In rare cases where the in-toeing is severe or caused by metatarsus adductus, bracing or casting may be recommended to gradually correct the foot’s position.
  6. Surgery: Surgery is very rarely needed for in-toeing and is only considered in extreme cases where conservative treatments have not been effective.

Preventing Complications

Proactive management of pigeon toeing is essential to prevent potential complications. Addressing the condition early can help avoid issues such as:

  1. Tripping and Falls: Children with severe in-toeing may be more prone to tripping and falling, leading to injuries.
  2. Abnormal Gait Patterns: Prolonged in-toeing can lead to abnormal gait patterns, which may impact the child’s overall physical development.
  3. Foot and Leg Pain: In some cases, in-toeing can cause discomfort or pain in the feet, legs, or knees.


As parents, observing our children’s growth and development is both fulfilling and challenging. While some conditions like pigeon toeing may cause concern, understanding the causes, seeking professional help, and implementing appropriate interventions can go a long way in ensuring our children’s healthy foot development. At Bankstown Podiatry and Injury Clinic, our dedicated podiatrists Dr Bilal Khelladi is committed to providing expert care and support to address pigeon toeing in children effectively. Remember, early detection and intervention are key, so don’t hesitate to reach out to us if you have any concerns about your child’s foot health. Together, we can help your child put their best foot forward on the path to a healthy and active future.

Disclaimer: This blog is for informational purposes only and should not be considered medical advice. If you have concerns about your child’s foot health, please consult a qualified healthcare professional.

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