Introduction
One of the most frequent causes for referrals to pediatric orthopedics is deformities and angular variations of the lower limbs, with in-toeing most frequently occurring in infants and young children. The feet turning in, also known as in-toeing or pigeon-toeing, is seen when the infant starts to take tiny steps. In the first few years of life, it is typical. Neonatal have a femoral neck that is rotated forward by about 40 degrees at birth. The level of anteversion (femoral neck leaning forward in respect to the femur) roughly declines in half by the age of 10 years old. Any deviation from the anticipated course of limb development and rotation should be identified and distinguished from conditions impeding normal rotation and the continuation of early angulation. Pigeon toes are less prevalent as children enter adolescence since the condition often improves when children reach their teen years. Pigeon toes, however, could persist throughout adolescence and may pose a risk factor for arthritis.
What Is a Pigeon Toe?
Pigeon toes cause the child's toes to point inside rather than outward. Bones or joints that do not point in the appropriate direction frequently cause pigeon toes (misalignment). As the child learns to walk, the pigeon toes can be noticed, also known as in-toeing. Pigeon toes, though, are painless. When at rest or when walking, the child's feet could turn in. Pigeon toes are fairly common, even if they can seem different. Pigeon toes typically do not hurt, and as the kid gets older, the condition should go away on its own.
What Causes Pigeon Toes?
Most frequently, it is because of how the foot was positioned within the uterus before the baby was born. Infection can result from three conditions:
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Metatarsus Adductus:
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The metatarsals are the bones that extend from the toes to the ankle.
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The child's front foot turns inward when it is at rest.
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The child's foot has a half-moon-shaped curvature on the outside.
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If the pregnancy was breech, if there was insufficient amniotic fluid (oligohydramnios), and if any family history is present, the kid may be more likely to develop metatarsus adductus.
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Tibial Torsion:
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The shin bone (tibia). The inward tibial torsion of the shin bone, or tibia, toward the center of the body, is the most frequent cause of pigeon toes that appear between the ages of one and three. The child could appear bow-legged if their tibia is turned inward. By the time the child is five years old, this condition often gets better on its own.
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Femoral Anteversion:
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Femoral anteversion refers to the way the knee seems to be rotated inward with respect to the hip. It results from the thigh bone's inward rotation (femur). Parental transmission of this condition can occur in offspring. The positioning of the fetus in the uterus, often known as crowding, may cause femoral anteversion. Between the ages of three and six is often when femoral anteversion is first identified, after which it steadily declines.
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What Are the Signs of Pigeon Toes?
The child's inward foot rotation will be seen the moment they begin to walk. When the feet are at rest, standing, walking, or sprinting, they point in the same direction. When moving fast, kids with pigeon toes are more likely to slip and fall than their peers. If the condition continues into adolescence, arthritis may develop.
How Are Pigeon Toes Diagnosed?
Healthcare professionals frequently identify pigeon toes during normal checkups by doing flexibility tests as part of a physical examination and reviewing the child's medical history. The child may be observed by the pediatrician running and walking. If symptoms do not go away as they mature, consider X-rays. If the child still has intoned feet as they get older, into their later elementary school years, and it truly causes a lot of issues with running, walking, and daily activities, at that point the doctor may send the patient to a specialist.
How Can Pigeon Toes Be Treated?
In fact, the majority of kids do not require any kind of treatment. Naturally, the in-toeing improves. But if it does not resolve with time and is beginning to be associated with other factors, other treatment options such as casting and surgery are considered.
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The child's doctor could advise a series of casts to stretch and lengthen the muscles if the metatarsus adductus is severe or does not get better on its own.
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When a child begins standing and walking for a period of time, generally around age five, it normally gets better if the shin bone (tibia) is the cause. After six months, if severe tibia-related pigeon toes are still posing a functional concern, the doctor may suggest the patient consult a pediatric orthopedic surgeon to learn whether surgery is an option.
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If the thigh bone is rotated, the major therapy is to prevent the child from crossing their legs when seated. When kids enter school, the condition normally improves since they have to sit in chairs and are not on the ground as much. Children over the age of 11 who have severe cases may consider surgery.
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Exercises or physical therapy.
Since it is likely to get better on its own and does not need major treatment, it is important to stay away from non-prescribed treatments like corrective shoes, twister cables, daytime bracing, workouts, shoe inserts, and back manipulations. Since in-toeing frequently corrects itself over time, these do not address the problem and could even be detrimental because they obstruct regular play or movement. A child wearing these braces can also experience unnecessary emotional stress from peers and the obstruction of regular and usual activities.
Conclusion
Understanding the typical growth and development of children's lower limbs is crucial to learning about the variational conditions of the lower limb. Being patient, making sure the children with pigeon toes have supportive shoes, and watching to see whether it gets worse or better are better ways to navigate throughout the child’s infancy stage. Allow the infant to play and be active frequently as this condition will resolve on its own.
