A very common reason for children to be referred to the orthopaedic clinic is for intoeing. This is sometimes referred to as being pigeon toed or hen toed, and simply means that the child walks with their feet pointing inwards. It is usually what we would describe as a normal variant and very rarely requires treatment. It is common and usually affects both sides. Intoeing is thought to affect 1 in 6 of all children, and is therefore more common than being left handed!
The position of the foot in space is affected by three things:
- The shape or position of the femur
- The shape or position of the tibia
- The shape of the foot.
In most cases the intoeing is often due to persistent femoral anteversion and turns the whole limb in while the child walks. It is usually not a problem with the feet and therefore special shoes or insoles make little difference. In most children the intoeing improves gradually as they grow and is much less obvious by the time they reach the age of about 8.
Parents often comment that their child trips and falls more often at however this tends to resolve as the child grows stronger, develops more co-ordination and control of their muscles. Intoeing does not affect a child’s ability to walk and should not delay their development. It is often more evident when a child is tired and if they are more flexible.
Most will correct over time, but some children will be able to turn their hip in more than out even as an adult. Some parents will also be able to in-turn more. In lots of ways children often end up like their parents. There is nothing to stop the child walking with their feet pointing forwards if they want to. It just happens to be easier to walk the way they do. Many children improve with time. However, they often tend to intoe when tired, not concentrating or running fast.