What Is Pigeon Toe (Femoral Anteversion)?

One of the most common walking issues that prompts parents to seek an orthopedist for their child is pigeon toe, also referred to as intoeing or by its clinical name, femoral anteversion. The condition is characterized by the child’s feet pointing inward instead of forward when walking or running.

It’s natural to worry about how your child’s legs develop and grow. The hips and legs go through changes as your baby prepares to walk. These changes may resemble bowed legs, pigeon toes and “knock knees.”

These are natural phases needed to transition the child’s body from curled up in the womb to coffee-table cruiser. It’s all designed to make walking possible.

Growth Stages

Infancy

Infants have tight ligaments in the hips that keep their legs turned out. Often, their shins are twisted inward, possibly because of tight space in the womb. This condition is known as internal tibial torsion or metatarsus adductus (MTA). It’s a natural condition that children typically outgrow.

Toddler Years

Early walking is a clumsy process. Toddlers’ knees are turned out, and their feet are pointed straight ahead — little tykes don’t seem to be built for walking. If their shins are twisted inward, called internal tibial torsion, it can seem like the legs are bowed. The bow-legged stance can help toddlers balance as they try to stand.

At about 15 months, a child’s hips rotate inward. The feet may turn in even more, causing a pigeon-toed effect. Growth corrects this development over time, usually by age 3. At this point, parents may develop a new worry –—that the child may seem “knock-kneed.” This will improve as growth continues during the school years.

School Age

Pigeon toed, or intoeing, is the rule between 3 years and early teen years. Often, the feet look straight when the child stands, but the feet turn in as they walk. This is worse when they are tired. This condition is caused by the natural inward alignment of the thighbones and hips (femoral anteversion).

Alignment of the thighbones also allows some children to “W-sit.” This is a position impossible for most adults. W-sitting has no effect on hip development; it’s just a comfortable sitting position for many children. As a child grows, this position likely becomes less comfortable, and intoeing will decrease.

It’s important to know that anteversion is not linked to orthopedic issues in adults. It does not cause arthritis or other leg damage. Encouraging the child to sit “cross-legged” helps train the legs toward less intoeing when standing and walking.

Flat Feet

The rotation of the legs also affects the arches of the feet. It can cause the feet to roll inward and the arches to flatten when standing. Arches are flexible so they can handle the stress of walking, running and jumping. Doctors can test this by having the child stand on tiptoes. As they rise, the arches will improve, then flatten again as they go down.

Treatments

In the past, doctors recommended stiff corrective shoes and bracing to correct these natural rotational conditions. Parents were even told to place their children’s shoes on the wrong feet to reshape the bones and joints. These children’s legs and feet improved as a part of the normal development process, and it was assumed that shoes and braces corrected the issue. As it turns out, those clunky shoes and braces were not needed. Rotational changes in children’s legs and feet are natural. It takes years for children to achieve final leg alignment and function.

Every child is different. Every child is a work in progress. We work with you to monitor your child’s progress so they can have the best outcome.