Intoeing in Children

image of child's feet who has intoeing

What is intoeing?

It is normal to worry if your child has adopted a walking style or gait that is different from their peers.

Intoeing, also commonly known as being “pigeon-toed”, is a common condition that we see here at our podiatry clinic.

It occurs when the toes are pointed inwards towards the midline of the body.


What does intoeing feel like?

Intoeing/pigeon toes may not cause any symptoms.  However, some patients will complain of pain in their hips, knees, ankles and feet.

Due to the position of the lower limbs, children who have an in-toeing gait may trip over more than their peers.

You may also notice that the soles of your children’s shoes are more worn through the medial aspect near the big toe, as well as the very end of the shoe.


What causes pigeon toes?

There are a few factors that can cause pigeon toes/intoeing. These may change depending on the age of the child.

Some of the factors include:

  • The foot is turned inwards (Metatarsus adductus) – This involves a curvature within the foot, where the toes tend to move towards the midline of the body.   It is sometimes referred to as a ‘banana foot’.  This may explain an intoeing gait that originates from the foot position and structure. See the diagram to the right.



  • The tibia is turned inwards (Interal tibial torsion) – This involves an internal rotation of the tibia bone of the lower leg.  This will change the position of both the knees and ankles. Seen in the image to the right.



  • The femur is turned inwards (Femoral torsion) – This involves an internal rotation of the thigh bone, also known as the femur.  This is present in children who have “knocked knees” and may also indicate a weakness of the muscles within the hip. See the image to the right.


Who does intoeing affect?

Intoeing commonly affects children between the ages of 2-5 years.  Approximately 10% of children are affected and intoeing usually resolves by the age of 8.

Intoeing continues into adulthood for about 4% of the population.

It also commonly affects those with cerebral palsy.


How is intoeing diagnosed?

An intoeing gait is typically diagnosed by a visual examination.

Thorough history taking will also give an insight into some of the reasons why intoeing may be present.  Some of the questions we might ask include gestation period, birth, any time spent in the NICU and whether your child has met their milestones (crawling, standing, walking) on time.

We will also assess the range of motion of the hips, knees, ankles, and feet, as well as observe your child playing and walking.

Joint hypermobility may be a contributing factor to intoeing.

We will also use what we call the Beighton scale to assess the overall flexibility of the joints throughout other joints of the body, including the wrist, elbow, knees and lower back.


How is intoeing treated?

  • Footwear

The right footwear is extremely important in supporting the feet and lower limb. Footwear can help to align the feet and provide cushioning and support.

  • Discourage W sitting

W sitting can be detrimental to the position of the hips, knees, ankles and feet.  While it might be your child’s preferred sitting position, however, it places the lower body in an improper position and alignment.

  • Simple mobilisation exercises

This will help to mobilise the joints within the feet and ankles, particularly in children with metatarsus adductus.

  • Stretching

A simple stretching program may be prescribed to relieve tension on the muscles that may be contributing to or being affected by an intoeing gait.  This may include stretching muscles of the lower back and thigh.

  • Orthotics

In some instances of intoeing, particularly those with metatarsus adductus, orthotic therapy can help in aligning the lower limbs and reducing the number of trips and falls.  Orthotics are not required in every case.


Discover some of the other the things to keep an eye out for when it comes to your kids feet in our article “What should I be looking for in my kid’s feet?“.

If your child walks with an intoeing gait, or they are experiencing any pain or discomfort in their feet and/or lower limbs, come see us today at Watsonia Podiatry.  You can easily book your appointment with one of our superstar podiatrists online here or by calling us on (03) 9432 2689.




Aaron Dri