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Pigeon toed or bowlegged - should I be worried?

The Doc Smitty gives the warning signs parents should look for

Children being “pigeon-toed” (in-toeing) or bowlegged are concerns of parents during the first two years of life. I remember seeing the shoes with the metal bar in-between in the top of my closet from attempts to correct in-toeing.

Most of the time there’s nothing to be concerned about, but I want to give you the reason why they happen and what you should worry about.


The most common cause is that the lower leg bone tilts outward. This might not be noticed until the child starts to walk, when parents will only notice because the foot turns inward. In addition some of the bones might be slightly rotated because of a tight fit in the womb.

These causes rarely result in problems walking. The complaint of, “My 18 month old falls all the time” is really hard to evaluate. We can generally wait a little bit to see if things improve. As the child walks, things will generally, slowly straighten out. The changes are so painfully slow that you may not notice any difference. Take pictures or videos of your child walking as these can be helpful.

As always, bring any concerns to your pediatrician but here are some warning signs:

  1. Does not resolve by age 3.
  2. Has a limp or complains of pain.
  3. Developmental delays (walking or other).
  4. Problems seem to be getting worse, not better.


Another common question (usually in the first year of life) is a child who is bowlegged. This can be noticed early on but, like in-toeing, is often identified after the child starts to walk. Because of the way that babies are squeezed into the uterus almost all have some degree of “bowleggedness” at birth. Usually both legs and both the upper and lower legs are affected. This will almost always start to improve as bones remodel when the child starts to walk.

Again, take any concerns to your pediatrician, but here are the warning sign for bowed legs:

  1. Is not resolved by age 2.
  2. One leg is more affected than the other.
  3. Child’s length/height is not growing normally.
  4. The knee seems to shift outward with walking.

Most of you can rest assured that your child’s pigeon toes or bowed legs are normal. If you have questions or concerns, contact your Cook Children’s pediatrician.



About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.