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Are You Pigeon Toed?

Adult with pigeon toesAs I child I often heard adults refer to the way another child, sometimes an adult’s way of walking as ‘pigeon toed’. It was funny to me; because pigeons walked funny, and seeing someone walking like one, looked odd.
The term pigeon-toed, medically known as in-toeing is used to describe a person who points their toes inward while standing or walking. It is commonly seen in children and may resolve in very early childhood with no treatment or intervention.

Symptoms
Some symptoms associated with pigeon toe are:
• Feet pointing inward, as if the toes are touching
• Stumbling (in severe cases)
• Clumsiness
• Difficulty with normal activity
• Difficulty with shoes
• Pain

Causes
Pigeon toe is caused by one of three conditions: metatarsus adductus, tibial torsion, or femoral anteversion. Each condition is specific to its location, which are the foot, knee and hip respectively.

Metatarsus Adductus
The condition occurs when the foot tends to resemble a kidney, or when the metatarsus adductus, a common deformity noted at birth, causes the front half of the foot, or forefoot, to turn inward.
Approximately 1 to 2 babies per 1,000 live births are born with metatarsus adductus, which is more common in first born children. These babies rarely need treatment as they grow.

Tibial torsion
When there is an inward twist of the tibia bone, the shin is twisted and it is referred to as tibial torsion. The shin bones are located between the knee and the ankle. This is commonly seen in children learning to walk.
The leg would usually straighten out, but some children may continue to walk pigeon-toed until the leg bone is finished growing.

Femoral Anteversion
This can be the result of stiff hip muscles, due to the position of the baby in the uterus. It also has a tendency to run in families. Usually, a child’s walking style looks like that of the parent.
In some cases the hip has an inward twist at the upper thighbone, and the knee caps tend to point inward when the person is walking.

When to See Your Doctor
If you notice that your child is pigeon-toed, you should consider seeing a podiatrist for an accurate diagnosis and a better idea of what to expect. If your child is pigeon-toed and you believe it is getting worse, or if the child has not outgrown the condition, you should contact your doctor. Remember that tripping and falling are normal parts of learning to walk and are not always the result of being pigeon-toed.

Baby in a braceTreatment
In general treatment for this condition is dependent on the type of structural problems occurring.Therefore, children should be examined regularly by a podiatrist to ensure that the bones are developing correctly and the child’s gait is progressing correctly. Additionally, your child’s tolerance for specific medications, procedures, or therapies would be taken into consideration, along with your preference for type of treatment. In adults, it would have to be determined whether surgery is practical or not.

Metatarsus Adductus
Where treatment is required, the nature of it would vary depending upon whether the condition is flexible or fixed. Most flexible cases respond to conservative treatment, which includes passive stretching, bracing, and specialised shoes. If conservative measures fail, surgical correction will be necessary, especially in cases of club-foot.
It has been found that metatarsus adductus may resolve spontaneously (without treatment), in the majority of affected children.

Tibial Torsion
The twisting of the shin bones usually improves with time. As the child grows, walking will become more normal, usually around 5 to 8 years of age. Occasionally, braces or special shoes are prescribed by the doctor.
Surgery may be necessary for children who do not outgrow this condition by the age of ten.

Femoral Anteversion
The twisting in of the thigh bone usually improves with time. As the child grows, normal walking patterns typically resume by 8 to 10 years of age. Occasionally braces or special shoes are prescribed by the physician.
On rare occasions, femoral anteversion can be severe and surgery may be required to straighten the thigh bone.
Overall this condition is not said to be painful or bothersome, nor is it known to cause additional medical problems such as arthritis.

Complications
Although this condition sometimes goes away on its own, in some cases, it does not. This causes complications for both the parents and the child. Most complications are not serious though, even if the child does not outgrow the condition. Shoes are typically the biggest challenge, because of the curve of their feet, and this can be frustrating. So finding the right shoes can become costly.
On a positive note, pigeon toe in fact is sometimes considered beneficial for some athletes/sportsmen.

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