In-toeing or Pigeon Toes

In-toeing (often called "pigeon toes") is when a child walks with one or both feet turning inward rather than pointing straight ahead. It's a common finding in young children, is usually painless, and in many cases improves naturally as a child grows — but a proper assessment helps rule out other concerns and gives you peace of mind.

What is in-toeing?

In-toeing describes the inward rotation of the feet during standing and walking. While most children with in-toeing aren't in any pain, it can sometimes increase the risk of tripping and falls, and where it occurs alongside very pronated (flat) feet, some children report leg tiredness or knee discomfort.

It's usually first noticed when children begin walking and is most common in children under 8, though it can appear at any age during childhood. It may affect one or both legs.

What causes pigeon toes?

In-toeing typically stems from one of three areas of the lower limb [1]:

• Metatarsus adductus — the front part of the foot (and big toe) curves inward.
• Tibial torsion — the shinbone (tibia) is rotated inward.
• Femoral anteversion — the thigh bone (femur) is rotated inward at the hip.

Positioning in the womb — particularly where there wasn't much room for the legs and feet to move — is a common influence. The level of the limb involved helps guide the most appropriate management.

How does Blueprint Podiatry assess and treat in-toeing?

At Blueprint Podiatry in Tuggerah, our podiatry team takes the time to identify where the in-toeing is coming from before recommending any treatment. Because every one of our podiatrists is also a certified running coach, we place real value on detailed gait and movement assessment — watching how your child stands, walks and runs to understand their unique pattern.

Management is tailored to your child and may include:

• Footwear advice suited to their stage of development.
• Targeted exercises to help re-balance muscles and improve gait patterns.
• Custom orthotics where clinically indicated — scanned weightbearing and 3D printed in-house, as patient-matched left/right devices, with no external-lab delay.

In-toeing can be complex and frequently overlaps with other issues such as pronated or flat feet. Where the hip or leg position needs broader input, we work closely with other practitioners — often paediatric physiotherapists and osteopaths — to support your child's care. Your podiatrist will always explain your child's findings and treatment options clearly.

When should I seek help for my child's in-toeing?

It's worth booking an assessment if your child's in-toeing is only on one side, seems to be getting worse, is causing frequent tripping, or is accompanied by pain, limping or difficulty keeping up with peers. Early advice is reassuring even when no active treatment is needed.

Related services

• Customised Orthotics
• Biomechanical Assessment