An in-toeing or pigeon-toed gait is observed when the foot or leg rotates inward. This can be noticed on either one or both legs, and can occur from birth or can start to appear through childhood development. Parents often notice an in-toeing gait when their child is active with sports or sometimes even just watching them as they are walking. Concerns often arise when first noticing this positioning, or when pain or not keeping up with other kids becomes apparent.
In-toeing is due to one of three reasons (or a combination)
- The foot is turning inward
- The shin bone is turning inward
- The thigh bone is turning inward
When the foot is turning in
Your Podiatrist will assess the foot shape of your child to see if the foot is turned more inward than it should be. Metatarsus Adductus is the name given to the condition where the in-toeing gait is due to the foot shape. It is either a flexible or fixed position. It is often diagnosed soon after birth as it is due to positioning within the womb, and is treated through massage/stretching, splinting or casting and footwear recommendations. Sometimes when mild, the foot may simply be monitored over time as some children will grow out of it.
When the shin bone is turning in
Tibial torsion is when the tibia (shin bone) itself is slightly twisted inward between the knee and ankle. It is the most common cause of in-toeing and is usually diagnosed when children start to walk. It equally affects males and females and most often affects both legs. It usually corrects without treatment and resolves by the age of 8 years old. Movement patterns can be addressed to work on correcting this positioning when caught early on. Strength and movement patterns can still be worked after the age of 7 or 8 years of age, however it may become more difficult to change as bony positions are set.
When the thigh bone is turning in
Normal femoral (thigh) positioning should reduce from infancy to the age of 8 where the bony positions are set. As shown in the image, the thigh bone develops with a bias toward an inward twist, relative to the knee and hip. Spontaneous correction can occur up to the age of 8 due to bony plasticity and adaptability. Past this age, corrections can occur with muscle strength, positional cues and stability work.
When to seek help for your child?
Generally the earlier intervention the better. The later that in-toeing is left, the more difficult it becomes to fix due to learnt movement patterns and muscle/bony adaptations.
We recommend that you have your child assessed by our Podiatrist’s if:
- You have noticed an in-toeing gait either over time or if it has recently developed
- Your child frequently trips over
- You’ve noticed slowing of pace with walking and running
- Your child is not keeping up with the other kids their age
- You are worried about the way they are walking and running
- Something doesn’t look quite right with their foot and leg positions
- They are experiencing pain in their feet, legs or hips
- There is a family history of foot and legs problems
Children’s feet and legs are often easily corrected with early intervention.
Our friendly Podiatrist’s are ready to help your child walk and run correctly!