Is walking “in toed” or “pigeon toed” normal?

I get asked this question all the time by parents.  And the answer is not a simple yes/no, in fact the answer is, it depends.

 

It is normal for a child to walk in toed at certain developmental stages and many pediatricians dismiss it for this reason.  However, once a child reaches the age of 11 (girls) or 12 (boys), in toeing should no longer be present.

 

The normal kind of in toeing comes from an internal rotation at the hip joint from birth which slowly rotates outward as the child grows.  The abnormal kind can come from the hips as well, but can also be from the lower legs, ankles and/or feet.  These types appear very similar to the normal kind but have differences.  If addressed early, these issues can be improved, helping to avoid problems in adulthood.

 

The evaluation for abnormal in toeing focuses on the various joints that create the abnormality.  These joints are examined while sitting, standing and walking as well as with x-ray.  The most common sitting position is a “reverse Tailor’s” or “scissor” configuration where the child sits on their feet, which are turned outward.  This is the opposite of a “pretzel style” or “Indian style” sitting.  When standing, the child may exhibit no signs of toes pointed inward, but they often have a flat arch (or a very high arch) and parents notice that their tendons or muscles are very tight (the Achilles Tendon is often tight when standing in these children).  When walking, the child will turn their toes toward the center line and sometimes the feet will cross one another.  Many times this walking leads to tripping and parents often are concerned that their child is clumsy.

 

The treatments for abnormal in toeing depend on the type but range from over-the-counter or custom insoles to surgical correction.  Surgery is the last resort in nearly all cases, and most children respond very well to conservative care.  If you have a concern about your child in toeing, the evaluation is fast and pain free.