Patient Education

To help you understand and navigate through your orthopedic health decisions, we have created a patient education section. Please select from one of the categories below to learn more about your condition or procedure.

Intoeing, also known as “pigeon toes,” is a condition where the toes point inward when walking or running. This is common in children and usually corrects itself as they grow. Intoeing can arise from issues in the foot, tibia (shinbone), or femur (thighbone).

Common Symptoms

  • Inward Pointing Toes: The most obvious sign, especially noticeable when walking or running.
  • Tripping and Falling: Increased frequency due to the altered foot positioning.
  • Gait Abnormalities: Noticeable inward rotation of the legs during movement.

Cause & Anatomy

Causes and Risk Factors:

  • Metatarsus Adductus: Inward turning of the front half of the foot. This is a common cause of intoeing in infants.
  • Tibial Torsion: Inward twisting of the tibia, common in toddlers.
  • Femoral Anteversion: Inward twisting of the femur, usually observed in preschool and school-aged children.
  • Genetics: Family history can play a role in the development of intoeing.
  • Developmental Factors: Position of the baby in the womb can contribute to intoeing.

Anatomy of the Leg and Foot:

  • Foot: The structure of the foot, including the toes and arches.
  • Tibia: The larger of the two bones in the lower leg, commonly referred to as the shinbone.
  • Femur: The thighbone, which is the longest bone in the body.


  • Assessment of the child’s medical history, family history, and development.
  • Physical examination to evaluate the gait and foot alignment.
  • X-rays: Rarely needed but can be used to evaluate bone alignment in severe cases.


  • Encourage Proper Footwear: Ensure that children wear appropriate, well-fitting shoes.
  • Promote Physical Activity: Encourage activities that promote normal muscle and bone development.
  • Regular Monitoring: Keep an eye on the child’s gait and development to catch any persistent issues early.

Non-Surgical Treatment


  • Many cases of intoeing resolve on their own as the child grows. Regular monitoring is often sufficient.

Physical Therapy:

  • Exercises to improve muscle strength and coordination.
  • Stretching exercises to address muscle tightness.

Footwear Modifications:

  • Wearing supportive shoes to encourage proper foot alignment.
  • Avoiding overly restrictive or ill-fitting shoes.

Surgical Treatments

Surgery is rarely necessary for intoeing unless it is severe and causing significant functional problems or pain. Procedures might include correcting bone alignment in severe cases.


  • Follow-Up: Regular check-ups to monitor progress and ensure that the condition is improving with growth.
  • Continued Exercises: Maintenance of physical therapy exercises to support proper gait development.

Potential Complications

  • Persistent Gait Issues: Rarely, intoeing can persist into adulthood and cause gait abnormalities.
  • Functional Problems: Severe cases might lead to issues with walking or running if not addressed.


Is intoeing painful?
Intoeing is typically not painful and does not cause discomfort in most children.

At what age should I be concerned about intoeing?
Most cases resolve by age 8. If intoeing persists beyond this age or is causing significant issues, consult a healthcare provider.

Can intoeing affect athletic performance?
In most cases, intoeing does not affect athletic performance. If it persists or causes functional problems, physical therapy may help.

Are there any specific exercises to help with intoeing?
Yes, specific stretching and strengthening exercises recommended by a physical therapist can help improve muscle balance and gait.

Can intoeing be prevented?
Intoeing is usually due to developmental factors and genetics, so it cannot always be prevented. However, ensuring proper footwear and encouraging normal physical activity can support healthy development.

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