In-Toeing (Pigeon-Toed Walking) in Children
In-toeing is when a child walks with the feet pointing inward. It is very common in young children and is usually a normal part of development.
Most children under 3 years of age show some degree of in-toeing and naturally grow out of it.
If it continues beyond early childhood, an assessment may be needed to identify the cause.
Why does in-toeing happen?
The cause usually depends on the child’s age.
| Age | Most likely cause | |
| Infants | Forefoot shape (Metatarsus adductus) | |
| Toddlers | Shin bone twist (Internal tibial torsion) | |
| 3–8 years | Hip rotation (Femoral anteversion) |
The front of the foot curves inward while the heel remains straight.
Often noticed in babies.
Symptoms
Most cases improve naturally.
Flexible foot (most common)
No surgery required.
Stretching exercises
Hold the heel steady and gently push the forefoot outward
Hold for 10 seconds × 6 repetitions daily
Only if significant tripping persists.
Options:
Fixed metatarsus adductus (rigid foot)
More uncommon and often associated with neurological conditions.
Treatment:
Common in toddlers when they start walking.
Children:
Treatment
Natural history
Usually corrects by 6 years of age
Treatment
Non-operative (most children)
No braces or physiotherapy change the bone rotation.
Helpful measures:
Surgery
Considered only after age 6 if severe and functionally limiting.
Procedure:
Recovery depends on fixation method.
Most common cause between 3–8 years.
Typical signs:
Natural History
Usually improves by 10 years of age
Treatment
Most children need no treatment
May Use:
Surgery
Considered only if persistent after age 10 and causing functional problems.
Procedure
Key message for parents
✔ In-toeing is very common
✔ Most children grow out of it naturally
✔ Special shoes or physiotherapy do not change bone rotation
✔ Surgery is rarely required and only for severe persistent cases
