Got a pigeon-toed child?

HEALTH matters

Pigeon toes, bowed legs, knock knees. These common foot and leg deformities of childhood cause some of the earliest worries for parents and have been the inspiration for countless contraptions to try to fix them. If you’ve recently looked at your baby or toddler’s legs and thought,"hmmm, that looks funny,” quickly followed by,"uh oh, what if they don’t straighten out?” then this article is for you.

Let’s start at the floor and work our way up.

There are three main reasons why toes point in. The first is called"metatarsus adductus,” medical jargon for"toes pointing in because the bones of the foot point in.” With this, the foot curves inward from the middle, kind of like the shape of a kidney bean. When the child stands up you can actually see the foot bending a bit. This may be noticeable into the toddler years. Another reason is a curvy shin bone. The medical word is"tibial torsion” because the shin bone (tibia) actually twists inward as it moves between the knee to the ankle. The knee points straight ahead, but since the foot attaches to the bottom of the shin bone, the foot will turn inward. The third source of toes that point in comes from the thigh bone or femur. In this condition both the knee and the ankle point inward because the femur sits in the pelvis in a forward position that causes the entire leg to point inward.

Determining which problem is afflicting your child may be frustrating to you as well as to your pediatrician. The good news is these are normal changes that occur as children grow, and in the vast majority of cases no treatment is needed. In some cases when the foot is very rigid and points inward, casting may be recommended to train the foot to stay in a normal position.

Now to the knee: Children are born with a slight bow in their legs because of their curled position in the womb. This is especially noticeable when they are held in a standing position around 3 or 4 months old. Around age 1, when a child starts to walk, their legs slowly straighten out. By age 3, their legs may appear slightly knock kneed. As they continue to grow, their legs will change again until they have a normal adult appearance. Of course, there is a wide variation of what that means, but in general, by the time we’re done growing most people’s legs are fairly straight and may have only a slight bow or slight knock kneed appearance.

In rare cases the look of the bones of the legs can be the sign of a significant medical condition. Your pediatrician may do some preliminary testing and then will probably send your child to either a pediatric rheumatologist, a pediatric orthopedic surgeon or someone like me who specializes in pediatric physical medicine and rehabilitation.

The key thing to remember is that children’s bones go through a lot of shaping and re-shaping as they develop.

If you’re really worried and you think your child has excessive pigeon toes, bowing or knock knees, talk to your pediatrician. But if your child is otherwise healthy and growing well, it may be best to wait until after age 4 or 5 before you really start worrying because for most kids, time is the only treatment they need.

Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at

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