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Signs and symptoms

The turning in of the toes is easy to see; if the condition persists, 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. To discern tibial torsion, place the infant or child on his or her 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.

Femoral torsion or anteversion usually does not appear until age four or five; from then on it gradually worsens. It can be detected by rotating the thighs at the hip joint. If the thighs make a larger arc internally than externally the child has femoral torsion.

Home care

By three months of age, your infant will prefer to sleep with the toes directed outward. This position is normal and should be encouraged. 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. A tendency to toe in after three months of age should be called to your doctor’s attention.


• An uncorrected adductovarus deformity makes it very difficult to fit the child’s shoes properly; this may eventually lead to the child developing 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 or her haunches with the toes directed outward.

• 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 or not.

Medical treatment

Your doctor will observe the child while he or she stands and walks both with and without shoes. The feet, the lower and upper legs, and the rotation of the hips will be examined. If necessary, your doctor will instruct you in massaging your child’s feet to correct mild toeing-in. If this 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 anteversion 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.


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