My neighbor’s son, a 5 year old boy, has an abnormal gait. He finds it difficult to walk properly. His parents always face problems when purchasing shoes for him, as none would fit him. The reason- he has inwardly turned feet. In medical terms the condition is called as ‘intoeing’ or pigeon feet.
About Intoeing
Normally, our feet point outwards, but in certain children the feet point inwards. This condition is called as intoeing or pigeon feet. Intoeing does not cause any serious problem or arthritis. In most cases, intoeing goes away on its own, but if doesn’t, then treatment is necessary. In few cases there may be a severe twist in femur (thigh bone) or tibia (leg bone) which will make the legs look awkward, and will need surgery for correction.
Causes
The three main causes of intoeing are metatarsus adductus, internal tibia torsion and excessive femoral anteversion.
Metatarsus adductus is a condition where there is a curve in the child’s foot and it can be noticed immediately after birth. This happens when the legs get pressed in a curved position in the fetus itself. In 9 out of 10 children, the feet may straighten up as the child grows up. The parents are taught to straighten the baby’s foot by stretching it.
If there is a twist in the leg bone between the ankle and knee (tibia), then it is called as internal tibia torsion. This condition may be noticed by parents when the child begins to walk. The twist has to straighten on its own during the first year of the child. In some children, it does not get straightened, leading to walking with toes inwardly pointed.
When there is an inward twist in the thigh bone (femur), then it is known as excessive femoral anteversion. This is seen in children between 2 years to 4 years of age.
Diagnosis
Diagnosis is made by studying the data from a torsional profile which consists of measurements like foot progression angle, thigh foot angle, hip internal rotation, hip external rotation and heel bisector line. All these measurements are done in a physical examination of the child.
Treatment
If the cause of Intoeing is metatarsus adductus, and the curving of the feet does not go away by stretching then braces or casts have to be fixed to the feet to straighten them. Braces and casts are fixed when the infant is between 4 months to 6 months old and is continued till the walking age of the child is reached.
In children with Internal Tibia torsion a bar with shoes attached to it is used to make the child’s feet turn outward. Usually, children may not cooperate in wearing them, so they are not advised for very young children. The twist in the feet may remain for some children but it does not lead to conditions like arthritis, and they will not have problems in running. For proper appearance of feet, surgery is recommended where the bones are cut and made to turn outward, so that the feet point outward.
Excessive femoral anteversion goes away when the child is 6 to 8 years of age but in severe cases when the condition is still persisting even after 8 years then surgery is recommended in which the bone is cut and made to turn outward so that the feet turn outward. Braces cannot help in this condition.
Calling your doctor
The inward turn of the feet gradually comes back to normal angle as the child grows in most of the cases. These changes are difficult to notice. Doctors recommend video recording of the child’s gait every year to check if there is any improvement in gait of the child. If the child is continuing to have intoeing even after 8 years of age and the appearance and gait is a worry to the parents, then the doctor must be consulted for treatment.
Pigeon toes ‘cute’ in Japan
It is interesting to note that majority of the Japanese women walk with their feet turned inwards. While it is considered as an abnormal gait in other parts of the world, pigeon feet are considered feminine and cute in Japan. A Japanese woman with intoeing is considered very attractive. The Japanese men have no intoeing. Intoeing walk by women is called ‘uchimata’ in Japanese and women have been encouraged to walk this way since ages.
