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 and, when not the result of simple muscle weakness, 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 persons foot is turned in. Causes
The cause of in-toeing can be differentiated based on the location of the misalignment. The variants are:
Curved foot (metatarsus adductus)
Twisted shin (tibial torsion)
Twisted thighbone (femoral anteversion)

Metatarsus adductus
The most common form of being pigeon toed, when the feet bend inward from the middle part of the foot to the toes. This is the most common congenital foot abnormality, occurring every 1 in 5,000 births. The rate of metatarsus adductus is higher in twin pregnancies and preterm deliveries. Most often self-resolves by one year of age and 90% of cases will resolve spontaneously (without treatment) by age 4.Signs and Symptoms
C-shaped lateral border of foot
Intoeing gait
Pressure sites during shoe wear

Tibial torsion
The tibia or lower leg slightly or severely twists inward when walking or standing. Usually seen in 1-3 year olds, internal tibial torsion is the most common cause of intoeing in toddlers.
The German Dermatological Society indicated that Diosmin may be used with other treatments for symptoms of chronic venous diseases.The American Society of Colon and Rectal Surgeons mentions phlebotonics as a possible treatment for symptoms of hemorrhoid grades I to II, as there is only moderate-quality evidence of effectiveness with "expectations of minimal harm", while having no evidence of long-term benefit. French, Indian, Portuguese, and Italian professional societies of coloproctology issued similar recommendations regarding phlebotonics for hemorrhoids. Adverse effects
In some 10% of users, diosmin causes mild gastrointestinal disorders or skin irritations (hives, itching), stomach pain, nausea, heart arrhythmias, or anemia. Preliminary research indicates no evidence of toxicity. The US Food and Drug Administration (FDA) concluded in 2001 that there was inadequate evidence on which to base an expectation of safety. As of 2013, the FDA did not revise this position. Regulatory status
Diosmin is distributed in the U.S. as a dietary supplement called Daflon. Diosmin is not approved as a prescription drug in the United States or Europe. Phlebotonics are not approved in Germany, and are restricted in Spain only for the treatment of chronic venous diseases. See also
Daflon
Venalex


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