X-ray of pigeon toe

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Author: Mikael Häggström [notes 1]
Pigeon toe or metatarsus adductus is where the toes to point inward when walking. It is most common in infants and children under two years of age.[1]



Indication for projectional radiography ("X-ray")

Pigeon toe can be diagnosed by physical examination alone.[2] This can classify the deformity into "flexible", when the foot can be straightened by hand, or otherwise "nonflexible".[2] Still, X-rays are often done in the case of nonflexible pigeon toe.[2]


A Sgarlato's angle of more than 15° indicates pigeon toe.[3]

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).[4] Many variants of this measurement exist, but Sgarlato's angle has been found to at least have favorable correlation with other measurements.[5] Sgarlato's angle is defined as the angle between:[3][6]

  • A line through the longitudinal axis of the second metatarsal bone.
  • The longitudinal axis of the lesser tarsal bones. For this purpose, one line is drawn between the lateral limits of the 4th tarsometatarsal joint and the calcaneocuboid joint, and another line is drawn between the medial limits of the talonavicular joint and the 1st tarsometatarsal joint. The transverse axis is defined as going through the middle of those lines, and hence the longitudinal axis is perpendicular to this axis.

This angle is normally up to 15°, and an increased angle indicates pigeon toe.[3] 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.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. . Pigeon toe (in-toeing). University of Iowa Hospitals and Clinics (2005). Retrieved on 2008-11-27.
  2. 2.0 2.1 2.2 . Metatarsus Adductus. Lucile Packard Children's Hospital. Retrieved on 2018-02-03.
  3. 3.0 3.1 3.2 "A reappraisal of the relationship between metatarsus adductus and hallux valgus ". Chin. Med. J. 127 (11): 2067–72. 2014. PMID 24890154. Archived from the original. . 
  4. 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 12687731. 
  5. Michael Crawford, Donald Green. METATARSUS ADDUCTUS: Radiographic and Pathomechanical Analysis. The Podiatry Institute.
  6. 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.