Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.

Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon.

If your child walks with their feet turned inward at the toes, they may be described as being pigeon-toed. This "toeing in" of the feet occasionally occurs as your child is starting to learn to walk, and it may continue through toddlerhood. It is noticed more often in children than adults, but occasionally older people may experience it.

Pigeon-toed walking is rarely a major orthopedic problem, and most often it goes away without treatment. But there are times in which it may impact your child's lower extremities and hips. In these rare cases, bracing or surgery may be necessary to correct the problem.

This article explains pigeon-toed walking, the causes and conditions associated with it, and common treatments.

If you notice your child's toes turn inward when they walk or run, then they may be pigeon-toed. There usually is no need to worry, as this condition likely is not permanent and will go away in a few years. Still, it is a good idea to check in with your healthcare provider to ensure your child is developing normally.

Occasionally, you may see an adult who walks with their toes turned in. This may be due to a birth defect, a weakness, or it may be a rare case of pigeon-toed walking as a youth that never went away.

There are several possible reasons for pigeon-toed walking. To be certain of the cause of your child's walking condition, visit your healthcare provider. A provider can assess your child's condition, make a diagnosis of pigeon-toed walking, and, if necessary, provide options for treatment, including:

In most cases of pigeon-toes, the child does not complain of any pain. If pain is felt, it can include:

Usually, you will notice pigeon-toes when your child is first learning to walk. Rest assured, your child most likely is not experiencing pain. They simply have feet and knees that turn inward when they walk and run.

Visit your healthcare provider if you notice your child is walking pigeon-toed. A pediatrician or primary care provider can assess the situation and make recommendations to correct the child's gait.

Most children who are pigeon-toed begin walking and running normally after the age of 3 or 4, so a watch-and-wait approach to care is typically recommended.

You may have to take your child to a specialist, like an orthopedic surgeon, if they are complaining of pain while walking. If your child is not able to walk due to the inward turn of their feet, then you should visit a specialist.

Pigeon-toed walking is not a preventable condition but rather one that develops during pregnancy. Causes may include:

None of these risk factors is readily modifiable, so there is no way to correct for pigeon-toeing as it develops. And in most cases, children who walk pigeon-toed simply grow out of the condition in time.

If you are an adolescent or adult and notice your knees turn in and you are walking pigeon-toed, you may have weakness in your hip and leg muscles that control the position of your legs when you walk. Strengthening those muscles should be helpful.

If you and your healthcare provider suspect that your child is walking pigeon-toed, simple things can be done to diagnose the condition. Most cases are diagnosed by clinical examination. Your healthcare provider may palpate (examine by touch) your child's lower extremities, looking for signs of metatarsus adductus, tibial torsion, or femoral anteversion.

A gait analysis may be done as well. In this, your child's healthcare provider may watch how the child walks and look for signs of inward-pointing toes and knees when walking.

An X-ray may be taken to assess the degree of tibial torsion or femoral anteversion present.

As stated previously, most cases of pigeon-toed walking simply go away in time. Typically by the age of 3 or 4, a normal gait will appear.

Other treatments for pigeon-toed gait may include:

Surgery should only be done as a last resort and for the most serious and unremitting cases of pigeon-toed walking. Most often, surgery is done to correct the position of the tibia if it is twisted, and it is performed once the child is over the age of 10 or 11 and continues to walk pigeon-toed despite conservative measures.

If your child is walking with their toes pointed in, they may be pigeon-toed. This condition is common, affecting about 1 in 5,000 children, and it typically is caused by abnormal birth positions in utero. Most of the time, pigeon-toes go away on their own with no treatment necessary.

We all want our children to grow and develop normally, but sometimes slight problems may lead to noticeable functional characteristics. Pigeon-toed walking is one of those problems. Mild changes in bone shape and positioning usually cause pigeon-toes. Often, it subsides in a few years as your child continues to develop. A watch-and-wait approach to care is typically all that is needed in cases of pigeon-toed walking.

Yes. A physical therapist is a movement expert who can assess you for tight or weak muscles that may be leading to pigeon-toed walking. They can then find the right exercises and strategies to help correct pigeon-toed walking.

If you have tight or weak hip and lower extremity muscles, you may be able to stretch and strengthen those muscles to correct pigeon-toed gait deformity. Wearing shoe orthotics may also correct your foot position. In severe cases, surgery may be needed for pigeon-toed walking.

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Paramanandam V, Lizarraga KJ, Soh D, Algarni M, Rohani M, Fasano A. Unusual gait disorders: a phenomenological approach and classification. Expert Review of Neurotherapeutics. 2019;19(2):119-132. doi:10.1080/14737175.2019.1562337

Uden H, Kumar S. Non-surgical management of a pediatric intoed gait pattern - a systematic review of the current best evidence. JMDH. 2012;2012(27):27-35. doi:10.2147/JMDH.S28669

Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat. 2020;237(5):811-826. doi:10.1111/joa.13249

Eamsobhana P, Rojjananukulpong K, Ariyawatkul T, Chotigavanichaya C, Kaewpornsawan K. Does the parental stretching programs improve metatarsus adductus in newborns? J Orthop Surg (Hong Kong). 2017;25(1):230949901769032. doi: 10.1177/2309499017690320

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