Why is my child in-toeing? Why is my child pigeon toed?

Pigeon Toed

There are several causes that may make your child appear to be in toeing or pigeon toed. Perhaps the most common cause is tight internal rotator muscles at the front of the hip which are usually brought about by foot pronation. Foot pronation will cause the leg to internally rotate with each step.  If this is the regular pattern of the child’s gait, that will become set in the muscles around the hip by stretching the muscles at the rear and not stretching the muscles at the front.

W Sitting

Often the child will consolidate this effect by sitting in the ‘W’ position – knees together in front and feet splayed out behind.  This position will give a very powerful stretch to the hip muscles toward encouraging pigeon toe. Children should be encouraged to sit cross legged / Indian style which will give a good (though less powerful) stretch in the other direction. Sitting in the W position must be forbidden! Some active exercises like doing the ‘Charlie Chaplin’ duck walk, ballet and breast stroke swimming can help.  Orthotics are likely to be required and can provide a very strong stimuli to move toward the correct hip orientation.  Often, they need only be worn for 1 or 2 years to achieve this. Preferably, treat this as early as possible to achieve better and quicker results. Sometimes, the restriction in movement toward outward rotation is a bony blockade in the hip joint rather than a muscular tightness. This cannot be fixed but can be accommodated to a degree. See a podiatrist for advice.

Metatarsus Adductus.

The inward curvature can be within the foot itself rather than at the knee.  This is called metatarsus adductus and it can be seen as a ‘C’ shaped foot.  It can complicate shoe fitting through life and, while it doesn’t cause great problems in itself, it has the tendency to be a destabilising force that makes all the other possible foot problems more severe than in a ‘normal’ foot. If found early enough, it can be manipulated to be entirely corrected.  From about the age of seven, it can be managed but not eradicated. To learn more about childhood pain, see our Growing Pains Info Sheet.  Alternatively, use this link to return to the Podiatry FAQs Blog.