Having a baby is simply a huge deal. This 18+ year commitment starts with an infant crying in the new world and goes forward through an amazing set of physical, mental, and emotional developments. As a parent, there is so much attention you need to give to your young one. Naturally, we recommend keeping an eye on your child’s feet and ankles to ensure everything is developing as it should. Of course, if you have any questions or concerns, Dr. Yuko Miyazaki will be glad to help.
One condition that parents often see is pigeon toes (intoeing). Intoeing stems from one of three possible roots – metatarsus adductus, tibial torsion, or femoral anteversion. Let’s examine these respective causes of pigeon toes.
The particular form of intoeing is known as metatarsus adductus entails your child’s feet bending inward from the middle part out to the toes, a condition which may somewhat resemble a clubfoot deformity in severe instances. Cases of this common finding can either be mild and flexible, or rigid and obvious.
Metatarsus adductus is best seen when you look at the sole of your child’s foot, particularly when he or she is still an infant. You will notice a pronounced curve in the foot, which likely stems from the feet being pressed into that position in the womb.
This often improves on its own, typically within the first 4 to 6 months. In the cases of babies aged 6 to 9 months old who have very rigid feet or a severe deformity, the use of casts or special shoes in treatment can be successful. Surgery is rarely needed to straighten the foot.
As opposed to metatarsus adductus, where the foot itself is the issue, tibial torsion is a twist in the tibia, one of the leg bones that runs between the knee and the ankle. A certain degree of inward twist for the bone is somewhat normal in babies, likely caused by the confined position the legs were in while the infant was in the womb. A baby’s legs normally rotate gradually during the first year to align in the proper position. Tibial torsion is when this correction doesn’t happen.
This form of intoeing will sometimes still be present when the affected child begins walking, which is often when parents first notice the condition. The feet do not point straight ahead, but the leg bones will continue to straighten until the child is 6 to 8 years old and the problem goes away.
Treatment options, including special shoes, splints, and exercise programs, are ineffective with this condition. The good news is that it naturally goes away on its own, typically before the child hits school age. When children still have a severe tibial twist at 8 to 10 years old that affects their gait, surgery may be used to re-set the bone and correct the deformity.
Whereas tibial torsion is caused by the tibia bone, femoral anteversion results from your child’s thigh bone (femur) being turned inward. Much like the other two cases for intoeing, femoral anteversion has its roots in the womb. During the fetus’ development, the femur advances with an abnormal rotation.
This cause of pigeon-toeing can start to show up between 2 and 4 years of age, right around when the child begins walking, but is even more apparent around 5 or 6 years. The top part of the femur has an extra amount of twist and it allows the hop joint to rotate inward more than it does outward. This leads to knees that point inward and feet to toe in when walking.
In a similar manner as with tibial torsion, femoral anteversion will correct itself in almost all children as they become older. Likewise, treatment methods that include braces, special shoes, and exercises are fruitless in helping. Surgery may become an option after age 9 or 10 for those who have a severe deformity.
When your child needs foot and ankle care, Dr. Yuko Miyazaki is here to help. We can find out what is causing your child’s intoeing and let you know what you can expect going forward. Our practice provides the first-class care and treatment that you want your son or daughter to have when things go wrong. Call us at (510) 647-3744 or use our online form to contact us for additional information.