“When life throws you a rainy day, play in the puddles.”
-Winnie the Pooh
Pigeon toed or in-toeing gait is when a child walks with their feet pointed inward. This pattern commonly comes from inward twisting, or torsion, of bones in the feet (metatarsus adductus), the shins (tibial torsion), or the hips (femoral anteversion). Internal torsion through the leg bones stems from positioning in the womb. The fetus’ limbs are rotated inward to fit into the small space. As the child grows and bears weight through the legs, derotation of the bones naturally occurs. Sometimes this derotation takes longer and we see kids walking with their toes pointing in.
In-toeing gait is associated with tightness of hip internal rotator muscles and weakness of the hip external rotator muscles. Commonly, parents complain of children tripping over their feet and falling more frequently than peers. Exacerbation of in-toeing gait occurs with persistent W-sitting. The W-sit position is related to femoral anteversion, tightness in hip internal rotators and weakness in hip external rotators.
The majority of children with in-toeing gait develop a typical gait pattern by the time they are in their teens and up to 99% of torsional abnormalities self correct by puberty. Surgery is only considered with severe torsional abnormalities. Surgery is not recommended until 5-6 years old for tibial derotation and 10-12 years old for femoral derotation. Most often, children are treated with observation. Researchers state potential changes may occur to the knee cap or foot bones due to compensatory alignment, however, there is no evidence showing long term consequences of in-toeing gait.
Addressing balance and muscular changes seen in children with in-toeing can be beneficial to optimize a child’s participation at home and in school. Here are some ideas for play:
- Promote sitting in long sit, circle sit, or criss-cross. Limit W-sitting.
- Animal Walks that promote external rotation motion and strength: Penguin walk, Frog jump, Bear walk, Lizard
- Balance beam, standing on one foot, kid’s yoga
You can refer to our blogs on W-sitting, animal walks, and kids yoga for more play details. Reach out to your pediatrician if you are concerned about your child’s in-toeing walk.