Pigeon toe

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Pigeon toe
Other namesMetatarsus varus, metatarsus adductus, in-toe gait, intoeing, false clubfoot
SpecialtyPediatrics, orthopedics

Pigeon toe, also known as in-toeing, is a condition which causes the toes to point inward when walking. It is most common in infants and children under two years of age[1] and, when not the result of simple muscle weakness,[2] normally arises from underlying conditions, such as a twisted shin bone or an excessive anteversion (femoral head is more than 15° from the angle of torsion) resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.

Severe cases are considered a form of clubfoot.[3]


The cause of in-toeing can be differentiated based on the location of the disalignment. The variants are:[4][5]

  • Curved foot (metatarsus adductus)
  • Twisted shin (tibial torsion)
  • Twisted thighbone (femoral anteversion)

Metatarsus Adductus[edit]

The most common form of being pigeon toed, when the feet bend inward from the middle part of the foot to the toes.

Tibial Torsion[edit]

The tibia or lower leg slightly or severely twists inward when walking or standing.

Femoral Anteversion[edit]

The femur or thigh bone turns inward when walking.


A Sgarlato's angle of more than 15° indicates pigeon toe.[6]

Pigeon toe can be diagnosed by physical examination alone.[7] This can classify the deformity into "flexible", when the foot can be straightened by hand, or otherwise "nonflexible".[7] Still, X-rays are often done in the case of nonflexible pigeon toe.[7] On X-ray, the severity of the condition can be measured with a "metatarsus adductus angle", which is the angle between the directions of the metatarsal bones as compared to the lesser tarsus (the cuneiforms, the cuboid and the navicular bone).[8] Many variants of this measurement exist, but Sgarlato's angle has been found to at least have favorable correlation with other measurements.[9] Sgarlato's angle is defined as the angle between:[6][10]

This angle is normally up to 15°, and an increased angle indicates pigeon toe.[6] Yet, it becomes more difficult to infer the locations of the joints in younger children due to incomplete ossification of the bones, especially when younger than 3-4 years.


In those less than eight years old with simple in-toeing and minor symptoms, no specific treatment is needed.[11]

See also[edit]


  1. ^ "Pigeon toe (in-toeing)". University of Iowa Hospitals and Clinics. 2005. Retrieved 2008-11-27.
  2. ^ Glenn Copeland; Stan Solomon; Mark Myerson (2005). The Good Foot Book. New York: Hunter House. pp. 96–97. ISBN 0-89793-448-2.
  3. ^ "pigeon toe" at Dorland's Medical Dictionary
  4. ^ "Intoeing". American Academy of Orthopaedic Surgeons. Retrieved 6 July 2013. Reviewed by members of the Pediatric Orthopaedic Society of North America
  5. ^ Clifford R. Wheeless III (ed.). "Internal Tibial Torsion". Wheeless' Textbook of Orthopaedics. Retrieved 6 July 2013.
  6. ^ a b c Chen L, Wang C, Wang X, Huang J, Zhang C, Zhang Y, Ma X (2014). "A reappraisal of the relationship between metatarsus adductus and hallux valgus". Chin. Med. J. 127 (11): 2067–72. PMID 24890154.
  7. ^ a b c "Metatarsus Adductus". Lucile Packard Children's Hospital. Retrieved 2018-02-03.
  8. ^ Dawoodi, Aryan I.S.; Perera, Anthony (2012). "Reliability of metatarsus adductus angle and correlation with hallux valgus". Foot and Ankle Surgery. 18 (3): 180–186. doi:10.1016/j.fas.2011.10.001. ISSN 1268-7731.
  9. ^ Michael Crawford, Donald Green. "METATARSUS ADDUCTUS: Radiographic and Pathomechanical Analysis" (PDF). The Podiatry Institute.
  10. ^ Loh, Bryan; Chen, Jerry Yongqiang; Yew, Andy Khye Soon; Chong, Hwei Chi; Yeo, Malcolm Guan Hin; Tao, Peng; Koo, Kevin; Rikhraj Singh, Inderjeet (2015). "Prevalence of Metatarsus Adductus in Symptomatic Hallux Valgus and Its Influence on Functional Outcome". Foot & Ankle International. 36 (11): 1316–1321. doi:10.1177/1071100715595618. ISSN 1071-1007.
  11. ^ "Five Things Physicians and Patients Should Question" (PDF). American Academy of Pediatrics-Section on Orthopaedics and the Pediatric Orthopaedic Society of North America. Retrieved 24 February 2018.

External links[edit]

External resources