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Intoeing, or ‘pigeon-toe’, is a condition in which the foot turns inward when walking. The condition is typically recognised in infants and younger children, and may correct itself as childhood progresses.
Intoeing isn’t normally accompanied by pain, although it can result in increased gait instability and can also result in gait changes, particularly when mobilising at speed. If left untreated into adulthood, it can result in joint pain, as a result of misalignment.
Intoeing is associated with a number of developmental conditions. These include:
Metatarsus adductus: an incurve of the front part of the foot, resulting from position in the womb.
Tibial torsion: an inward rotation of the tibia, which causes inturning of the foot.
Femoral anteversion: an inward rotation of the femur, which causes the knees and feet to turn inward.
There is an additional genetic component to the development of intoeing, meaning that a familial history of the condition will increase the chance of presentation.
Most cases of intoeing will resolve on their own, with time. However, in severe or late-stage cases, non-surgical interventions may be neccessary. These include:
Physiotherapy: exercises here will typically target the muscles of the legs and hips to improve alignment.
Stretching and positioning: stretching exercises, like physiotherapy, can improve mobility and alignment; avoiding certain sitting positions which increase inward rotation can also support better hip alignment.
Casting: reserved for very severe cases and designed to gradually improve alignment over time.
Surgical options for intoeing are reserved for the most severe cases, where non-surgical options have failed to correct the incurve, and where the deformity is causing very significant negative impacts on mobility and quality of life. These include:
Derotational osteotomy: involves the cutting of the femur (or, much less commonly, the tibia) and its subsequent realignment. Once aligned, the bone will be secured in place with plates and screws to hold it in place during healing.
Soft tissue release: involves the release or lengthening of the tight tendons which pull the foot inward in cases of Metatarsus Adductus.
External fixation: inolves the gradual rotation and realignment of bone over time using an exernal frame. This is used only in very rare cases, and is considered a ‘last resort’ option given its complexity and long associated recovery time.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
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Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.