Q. My 5-month-old has inverted feet (pigeon toes). I was also pigeon-toed as a child and had to get casting. What do you suggest as treatment now? And will she grow out of this when she starts walking and crawling?
A. Nearly all newborns come into the world somewhat pigeon-toed. This normal incurving of the feet is due to their scrunched-up position in the womb. If you have ultrasound pictures of your unborn baby you will notice how her feet curve closely in toward her body. After birth, when there is more freedom of movement, the incurved feet of most infants gradually straighten out by themselves. Occasionally the front of the foot is curved in so much that it can't be straightened. This condition, called clubfoot, needs surgical treatment.
Test the severity of your baby's incurving. Here's how to tell whether your baby's feet exhibit normal, self-correcting incurving or are likely to need treatment. Hold the back of baby's foot with one hand and the front of baby's foot with the other. If you are able to straighten the foot by applying gentle pressure to the front, the incurving is most likely normal and requires no treatment. If, however, the incurving is too rigid to be straightened and you notice a deep crease on the bottom of the foot just in front of the heel where it curves in, treatment may be necessary -- usually by casts, and sometimes by surgery, depending on the severity.
If the incurving is rigid and not self-correcting, an orthopedic specialist may do a painless treatment called serial casting: Plastic casts resembling little white boots are placed on your baby's feet and changed every few weeks. Over the course of several months, the changing casts adjust baby's feet until the incurving is corrected. The castings are followed by special shoes that keep baby's feet straight for a few more months. Most likely, your baby has the normal incurving and won't need any orthopedic procedures. Here are some home remedies to help those little feet grow straight.
Put your baby to sleep on her back. According to the American Academy of Pediatrics, this is the safest sleeping position anyway, at least for the first nine months. Above all, don't let your baby sleep on her tummy with her feet curved under her tummy as she did in the womb. This is the most common cause of prolonged, incurved feet in a baby and intoeing in a toddler. Encourage her to sleep on her back or side. As she gets older, if she continues to sleep on her tummy with her feet tucked underneath her, go into her bedroom before you retire and pull her feet out from beneath her. In my pediatric practice, I have encountered toddlers who refused to sleep any way other than on their tummies with their feet curved beneath them. If these babies were developing severe intoeing, some mothers found it helpful to sew the pajama legs together, forcing baby to sleep with her legs straight out.
Stretch those little feet. Every time you change baby's diapers, hold the back of the foot with one hand and the front of the foot with the other and gently straighten. Hold each foot in this straight position for at least five seconds. Repeat this procedure ten times with every diaper change.
Teach your toddler to sit properly. Toddlers often like to sit back with their feet curved beneath their bottoms. Just like sleeping in the fetal position, sitting in this position can cause curvature of the feet and lower legs. As the saying goes, "As the twig is bent, so grows the tree." The bending of the legs and feet from these sleeping and sitting positions can cause those growing legs and feet to curve inward, a condition called internal tibial torsion.
Watch your child walk. As a general guide for children who walk pigeon-toed, no tripping equals no worry. If your child does not trip a lot when walking fast or running, chances are she will outgrow her pigeon toes with the help of the sleeping and sitting precautions mentioned above. Keep a diary: If you notice your child is tripping more instead of less as she masters walking, be sure to mention this to her doctor at her regular checkups. But rest assured, the great majority of infants and toddlers self-correct their intoeing as they get older.