$Unique_ID{PAR00129}
$Pretitle{}
$Title{Medical Advice:  Pigeon Toes}
$Subtitle{}
$Author{
Editors of Consumer Guide
Chasnoff, Ira J}
$Subject{Pigeon Toes Toeing in orthopedic corrective shoes adductovarus
deformity tibial torsion femoral torsion remoral anteversion toe foot
deformities feet leg legs thigh bone walk walks walking sit sits sitting stand
stands standing}
$Log{}

Your Child:  A Medical Guide


Pigeon Toes


     Quick Reference

     SYMPTOM
     - Toeing in (turning inward of the front part of the foot)

     HOME CARE
     - Encourage your infant to sleep with the toes turned outward by
       positioning his feet in that way as he sleeps.
     - If so instructed by your doctor, massage the child's feet to correct
       toeing in.

     PRECAUTIONS
     - Most cases of pigeon toes correct themselves; however, if the child is
       toeing in after the age of three months, consult a doctor.
     - Never allow a shoe salesperson to recommend orthopedic or corrective
       shoes for your child.  The prescription must always be made by a
       qualified medical professional.
     - If your child sits on the floor a lot, encourage him to sit
       cross-legged, not on his haunches.

     Toeing in (turning inward of the front part of the foot), particularly
when standing and walking, is known as pigeon toes.  After birth, the position
and shape of the feet and legs reflect the position they were in during the
baby's last weeks in the mother's womb.  By the age of three months, the
child's feet and legs should have assumed a normal shape.
     Throughout infancy and early childhood, however, the position of the feet
and legs can be influenced by the manner in which they are held while the
child is sitting and lying down.  Habitually sleeping face down with the toes
directed inward encourages the development of pigeon toes.
     Pigeon toes also may result from a malformation of the foot (adductovarus
deformity), of the lower leg (tibial torsion), or of the thigh bone (femoral
torsion, or remoral anteversion).  Depending on the severity of the
malformation, the child's toes will point inward to a greater or lesser
degree.  A child who has a marked malformation will tend to trip over his feet
until he learns to compensate for the condition.

SIGNS AND SYMPTOMS

     The turning in of the front part of the foot is easy to see.  If the
condition persists beyond the age of three months, it should be brought to the
doctor's attention.
     You can do a preliminary test for an adductovarus deformity of the foot
by laying a straightedge along the outer border of the child's foot.  If the
outer border of the foot is not absolutely straight from the heel to the
little toe, the child has adductovarus deformity.
     As a preliminary home test to discern tibial torsion, place the infant or
child on his back with the legs straight out, kneecaps pointed upward, and
feet at right angles to the lower legs.  If the toes point toward the midline
instead of straight up, the child may have tibial torsion.
     Your doctor will be able to detect whether your child has femoral torsion
by manipulating the hips and thighs.

HOME CARE

     By three months of age, your infant will prefer to sleep with the toes
directed outward; this is normal and should be encouraged by placing the
child's feet in this position as he sleeps.  When the child is old enough to
sit upright, the feet should be straight or turned outward.  Until 18 to 24
months, your toddler usually will walk with one or both feet turned outward;
this gives the child a wider base and better balance, and is normal.  Toeing
in after three months of age should be called to your doctor's attention.

PRECAUTIONS

  -  An uncorrected adductovarus deformity makes it very difficult to fit a
     child's shoes properly and may cause the development of a skewed foot and
     bunions in adolescence or adulthood.
  -  A child who sits on the floor a lot should be taught to sit cross-legged,
     not on his haunches.
  -  Corrective orthopedic shoes should be prescribed only by a medical
     professional, never by a shoe salesperson.
  -  Most minor cases of pigeon toes correct themselves.  Nevertheless, let a
     doctor judge if the condition is minor.

MEDICAL TREATMENT

     Your doctor will observe the child while he or she stands and walks, both
with and without shoes.  The feet, the upper and lower parts of the legs, and
the rotation of the hips will be examined.  Your doctor may instruct you in
massaging your child's feet to correct mild toeing in.  If massage does not
correct the condition by the time the child is three or four months old, your
doctor will order specific kinds of shoes or plaster casts.
     To correct tibial torsion, the doctor may prescribe a splint that holds
the feet outwardly rotated while the child sleeps.  In the case of femoral
torsion, the doctor may not start treatment until your child is a teenager; if
the condition has not corrected itself by that time, surgery on the thigh
bones may be necessary.