It is usually bilateral (both legs) condition that typically self-resolves by 4 to 5 years of age.Signs and Symptoms
Frequent tripping and clumsiness
Intoeing gait

Femoral anteversion
The neck of the femur is angled forward compared to the rest of the bone, causing a compensatory internal rotation of the leg. As a result, all structures downstream of the hip including the thigh, knee, and foot will turn in toward mid-line. Femoral anteversion is the most common cause of in toeing in children older than 3 years of age. It is most commonly bilateral, affects females twice as much as males, and in some families can show a hereditary pattern. This condition may progressively worsen from years 4 to 7, yet the majority of case still spontaneously resolve by 8 years of age.Signs and Symptoms
W-Sitting and inability to sit cross-legged
Intoeing gait
Circumduction Gait (legs swing around one another)
Frequent tripping and clumsiness

Diagnosis
Pigeon toe can be diagnosed by physical examination alone. This can classify the deformity into "flexible", when the foot can be straightened by hand, or otherwise "nonflexible". Still, X-rays are often done in the case of nonflexible pigeon toe. 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). Many variants of this measurement exist, but Sgarlatos angle has been found to at least have favorable correlation with other measurements.
Osteotomy (cutting of bone) and realignment of the medial cuneiform, cuboid, or second through fourth metatarsal the safer and most effective surgery in patients over the age of 3 years old with residual rigid metatarsus adductus.Internal Tibial Torsion
Nonoperative management:  There are no bracing, casting, or orthotic techniques that have been shown to impact resolution of tibial torsion. This rotational limb variant does not increase risk for functional disability or higher rates of arthritis if unresolved. Management involves parental education and observational visits to monitor for failure to resolve.Surgical management:  Indications for surgical correction are a thigh foot angle greater than 15 degrees in a child greater than 8 years of age that is experiencing functional limitations because of their condition. Surgical correction is achieved most commonly through a tibial derotational osteotomy. This procedure involves the cutting (osteotomy) and straightening (derotation) of the tibia, followed by internal fixation to allow the bone to heal in place.Femoral Anteversion
Nonoperative management:  Nonoperative treatment includes observation and parental education. Treatment modalities such as bracing, physical therapy, and sitting restrictions have not demonstrated any significant impact on the natural history of femoral anteversion.Surgical management:  Operative treatment is reserved for children with significant functional or cosmetic difficulties due to residual femoral anteversion greater than 50 degrees or internal hip rotation greater than 80 degrees after age 8. Surgical correction is achieved  though a femoral derotation osteotomy.