What is pigeon toe (femoral anteversion)?

One of the most common walking issues that prompt parents to seek an orthopedist is pigeon toe, also referred to as intoeing or by its clinical name, femoral anteversion. The condition is characterized by your 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 bow legs, pigeon toed and knock knees.

Remember these are natural phases needed to transition the body from bundled 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 conditions in the womb. This condition is known as internal tibial torsion. 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 – internal tibial torsion – it can seem like toddlers’ 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 – your 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 three years and early teen years. Often, it looks straight when the child stands, but the feet turn in as he or she walks. This is worse when they are tired. This condition is caused by the natural inward alignment of the thighbones and the hips (femoral anteversion).

Alignment of the thighbones also allow some children to “W-sit.” This is a position impossible for most adults. W-sitting has no affect 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 arch of the foot. It can cause the foot to roll inward and the arch to flatten when standing. The arch is flexible so it can handle the stress of walking, running and jumping. Doctors can test this by having the child stand on tiptoes. As they rise, the arch 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 problem.

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 he or she can have the best outcome.