This is test content. It hasn't been reviewed yet, and will be replaced with reviewed content.

Intoeing

Paediatric Foot Conditions· Also known as: in-toeing, pigeon toes, pigeon-toedUpdated Nov 2026

Not reviewed yet: test content

At a Glance

Intoeing, or pigeon toes, means a child's feet point inward as they walk or run. Babies, toddlers and young children are most often affected. Metatarsus adductus, the foot cause, is seen in roughly one to two of every 1000 newborns. Most of the time it is a normal variation that tends to get better as a child grows, and it rarely needs treatment. A practitioner or doctor can check where the turn comes from and whether anything needs more attention.

What is it?

Intoeing, often called pigeon toes, is when a child's feet turn inward instead of pointing straight ahead when they walk or run.

In most children it is a normal variation, not a sign that something is wrong. It is generally due to an extra twist in the thigh bone or the shin bone.

There are three places the inward turn can come from:

The foot: metatarsus adductus (the front half of the foot curves inward).
The shin bone: internal tibial torsion (the shin bone twists inward).
The thigh bone: femoral anteversion (the thigh bone twists inward).

It can come from one of these alone, or from a mix of them. Your podiatrist can work out which one is involved.

Who does it affect?

Intoeing is most common in babies, toddlers and young children.

The part of the leg that causes it usually changes with age. In babies it is most often the foot (metatarsus adductus). In toddlers it is most often the shin bone (internal tibial torsion). In children up to about 10 years old it is most often the thigh bone (femoral anteversion).

It isn't clear how common intoeing is overall. Metatarsus adductus affects about one to two babies in every 1000 births. It is the most common foot shape difference that babies are born with.

Signs and symptoms

The main thing you may notice is that one or both of your child's feet point inward when they walk or run.

What you see can depend on where the turn comes from. With metatarsus adductus, the heel itself looks normal. With femoral anteversion (the thigh bone twists inward), the feet turn inward when walking and the hip can rotate inward more than usual (over 70 degrees). Children with this often sit on the floor in a W-sitting position (sitting with the knees bent and the feet out to the sides).

If you notice any of the signs listed in the 'When to see a podiatrist' section, follow the advice there.

What causes it?

Intoeing can come from the foot, the shin bone or the thigh bone. Sometimes more than one of these is involved at the same time.

Foot. Metatarsus adductus often happens because space in the womb was cramped. It is there from birth.

Shin bone. Internal tibial torsion is often due to the leg being turned inward to fit in the womb. A twist in the shin bone is normal in newborns. As a child grows, the shin bone gradually turns outward. If that change doesn't happen, the intoeing may carry on.

Thigh bone. Femoral anteversion is thought to be the most common cause. Babies can have a thigh bone twist of up to 40 degrees, and this falls to about 15 degrees by young adulthood. It often goes along with W-sitting.

Intoeing that lasts or is severe is probably inherited. A clinician may ask whether other people in your family had intoeing.

How is it diagnosed?

Intoeing is usually diagnosed from your child's history and a physical examination. Your practitioner will take a history, such as your child's age, which side is affected, any pain or limp, family history, usual sitting positions and any other conditions. Then they will watch your child walk, looking at how the knees and feet point.

They will also check your child's hips, shin bones and feet. They look at how far the hips turn, how much the shin bone and thigh bone are twisted, and the shape of the foot. They also check the hips for other problems, such as hip dysplasia (a hip joint that hasn't formed as it should). Together, these checks are called the torsional profile. They show where the twist is and how much there is.

This hands-on check is usually enough to work out what is going on.

Treatment

For typical intoeing with no warning signs, most children need only to be watched. Their measurements are usually in the normal range, and these tend to settle as the child grows.

Looking after it at home

Mostly, no treatment is needed. Trying to change how your child walks won't help, and constant corrections to how they walk or sit can cause stress and anxiety, though it isn't clear yet whether avoiding habitual W-sitting helps. Special shoes, braces or inserts aren't needed for typical intoeing, so there is no need to buy them.

Treatment from your podiatrist

Your podiatrist will check where the turn comes from and keep an eye on it over time. Special shoes, braces or manipulation (including by a chiropractor) don't make normal toddler intoeing improve any faster. For a twisted shin bone (internal tibial torsion), special shoes, splints, bracing or exercises aren't needed either.

Most foot curves (metatarsus adductus) are flexible, which means they can be gently moved straight. These usually settle on their own and do not need treatment. For a foot that is only partly flexible (semi-rigid), it isn't clear yet how well treatment works. Options include stretching, splinting, serial casting, sitting and sleeping positions, and footwear or orthotics (shoe inserts).

Other options

A foot curve that is rigid can't be gently moved straight. A rigid foot, or a foot that is stiff, is referred for specialist review, usually with a paediatric orthopaedist (a children's bone and joint specialist). Specialist review is also the next step for intoeing that is one-sided, severe or not improving, rather than trying treatments at home.

Surgery

Surgery is a specialist decision. No firm ages or angles are set for it in typical intoeing. If it is ever suggested, talk through the risks and the timing with the orthopaedic team.

Recovery

The outlook is good for most children. Intoeing usually improves with growth, and treatment is not usually needed.

How long it takes depends on where the turn comes from. The foot curve (metatarsus adductus) usually improves by itself over the first 4 to 6 months of life. In almost all children, a twisted shin bone (internal tibial torsion) gradually untwists by itself as the walking pattern matures, though this can take years. Intoeing usually corrects itself by around age 8 to 10.

Some children still have it as adults. This rarely causes major problems, and most cases straighten to normal adult levels. Intoeing that lasts is probably inherited.

No set follow-up schedule is clear yet.

When to see a podiatrist

When to book

See a doctor if your child's intoeing is severe and not improving over time, affects only one leg, or gets in the way of their movement or activity. See a doctor too if their feet are stiff and not improving. Note whether one or both feet turn in when they walk and run, and check with your podiatrist that any advice suits your child.

When to get help sooner

Get urgent medical assessment (see your GP today, or go to an urgent care clinic or the nearest emergency department) if:

your child has a fever with a limp or a painful, red, hot or swollen joint, or seems very unwell with foot or leg pain: go straight away, without waiting for an appointment
your child suddenly has severe pain in one joint and is limping
you suddenly can't put any weight on your leg or foot, or have sudden severe hip pain or a change in the length of your leg: go straight away, without waiting for an appointment

See your GP soon if:

you have lost weight without trying
you have pain at night or at rest that doesn't settle
your child has a limp that hasn't improved after a week, limps without pain, or doesn't want to put weight on their foot
your child has heel or ankle pain together with hip or knee pain, morning stiffness that lasts more than 20 minutes, or a foot that has started to turn outwards

See your podiatrist or GP soon if:

your child's foot shape is getting worse
your pain is getting worse, or doesn't settle with rest, less activity or pain relief

Frequently asked questions

Does W-sitting cause intoeing?

A twisted thigh bone often goes together with sitting in a W shape, but it isn't clear yet whether habitual W-sitting adds to an intoeing walk or simply reflects that twist. It isn't clear whether avoiding habitual W-sitting helps, and trying to change how your child sits may not help and can cause stress and anxiety.

Will intoeing lead to arthritis or back pain later?

Usually not. Intoeing doesn't usually get in the way of physical activity, and it doesn't usually make arthritis or back pain more likely later in life. For most children it is a harmless variation that settles with growth.

Will my child need an X-ray or scan?

Usually not. A hands-on examination is normally enough. An X-ray is used to rule out other problems, for example if the hips move unevenly and the creases at the top of the legs are unequal, when a hip X-ray may be considered.