As children develop you may notice that not everything is on the “straight and narrow”. Children who walk with their feet turned inwards are described as being “pigeon toed” or having in-toeing. This is a very common clinical presentation which may involve one or both feet. In-toeing can be observed as part of a child’s normal development however, some forms of in-toeing can create additional problems and may warrant intervention. With in-toeing, children might be prone to tripping or may look awkward with walking or running.
What is the cause?
There are four common causes of in-toeing:
Metatarsus Adductus (curved foot)
The outside of the foot is normally straight. In metatarsus adductus, the long bones of the foot deviate inwards giving the foot a curved or banana-shaped appearance. This may be noticed at birth or in a baby’s first few months. It can affect one or both feet and is thought to be related to the position of the baby in the mother’s uterus. Metatarsus adductus typically corrects itself without treatment by walking age.
Internal Tibial Torsion (twisted shin bone)
This is where the bone of the lower leg twists inwards between the knee and the ankle. It causes the feet to turn inwards and take a ‘pigeon-toed’ appearance. Internal tibial torsion can also cause pronation (rolling in) of the foot and genu valgum (knock knees). Tibial torsion is very common in infancy and childhood as part of their bony development. This usually corrects with normal growth by about six years of age.
Internal Femoral Torsion (twisted thigh bone)
This condition is where the thigh bone turns inwards between the hip and the knee. It causes the feet to turn inward and take a ‘pigeon-toed’ appearance. This is commonly seen in children between the ages of three to six but usually slowly corrects itself by age nine or ten.
Tight Internal Hip Rotator Muscles
The main muscles that internally rotate the femur (thigh bone) at the hip are the tensor fascia lata and the gluteus medius. When these muscles are tight it can limit external rotation and therefore cause internal rotation of the whole leg. This position of the femur causes the knee and feet to turn inwards giving the ‘pigeon-toed’ appearance. Tight internal hip rotators are often found in conjunction with internal femoral torsion.
What treatment will be required?
Treatment for in-toeing gait is dependent on the cause and the contributing factors to the condition. Treatment may be recommended in children when the in-toeing is severe and there is little or no improvement over time or if in-toeing is only affecting one foot. Early intervention can assist in preventing future complications arising from poor foot posture and gait patterns. Common treatment options include:
- Changes to sitting and/or sleeping positions
- Footwear advice
- Stretching/strengthening program for specific muscle groups
- Orthotic therapy
- Serial casting
- Splinting
- Surgery intervention
When to see a podiatrist?
In-toeing is a normal stage of lower limb development. However, a consultation with your child’s podiatrist is required if in-toeing is:
- Only affecting one leg
- Causing pain in the legs
- Severe, and not improving with time
- Causing tripping in a school-age child which affects participation in activities
So, if you suspect your child may be in-toeing or would like a general lower limb assessment book in to see one of our podiatrists so they can take your child through a thorough paediatric assessment. Early intervention is key in preventing future complications! Call us now on 43239100 or BOOK ONLINE.
