Welcome to Play On Pediatric Therapy
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By: Katie Milliere, Physiotherapist (Pediatrics)
Being in-toed (walking pigeon toed) may never cause your child any problems, but it is possible that it could lead to a few different issues overtime. These could include: eventual hip, knee or foot pain; other changes in leg alignment and mechanics; increased tripping; more difficult coordination of the legs; increased risk of injury when participating in certain sports. Most kids will outgrow the condition, but some may not. In the very worst cases, surgery may be indicated, but this is very rare.
Metatarsus Adductus: This is commonly noticed in babies and is attributed to positioning in the uterus. It is when the front bones (metatarsals) in their feet are positioned inwards. Depending on the severity, their feet may look C shaped or curved.
Tibial Torsion: This occurs when your shin bone (tibia) rotates towards the middle, which then causes your foot to turn inwards. This is often seen in younger kids ages 1-3.
Femoral Anteversion: This is when your thigh bone (femur) is positioned forward, resulting in your legs and feet facing inwards. Kids with femoral anteversion may be able to sit in the W-position easily. This is typically noticed in kids 4 years old and older.
These changes in structure can happen for several reasons. Muscular imbalances are often a huge part of the picture! Some muscles may be tight on one side of the leg or hip and weak on the other, thus influencing the leg to turn towards the tighter side. For example, one hip might face internally as a result of the inside leg muscles becoming tight, and the outside hip muscles becoming weak. Our bodies are great at finding alternative ways to complete a movement, which results in some muscle groups working harder, and others not activating as much as they should. Additionally, you need proximal stability in order to be able to control your limbs effectively (which means better strength).
Proximal stability can be thought of as ‘Core strength’ (which includes the overall strength of the hips and associated muscles!!!) and is essential to helping you to control your movements. It becomes challenging to maintain balance and use your arms and leg muscles efficiently without a strong center/foundation. By working on core strength, fewer compensation patterns develop to perform various movements, navigate different surfaces, and coordinate body parts for walking, activities of daily living, and sports. Physiotherapists who specialize in working with children can make working on the core fun and engaging so they WANT to do their exercises!
Physiotherapy is a great place to start! During the assessment, the physiotherapist will identify the potential root cause as to why your child may present with one or both feet facing inwards. Interventions such as massage, orthotics, stretching, and strengthening exercises may be provided to help with your child’s specific challenges. Also, avoiding the “w”- sitting position may be beneficial to reduce the prolonged rotational torque applied to the bones, which may contribute to in-toeing if the child sits with the toes pointing inward. If during the assessment the physiotherapist finds something of more concern they can advise on next steps, such as consulting with your child’s pediatrician or family physician.
Are you wondering if your child may be in-toeing? Book an assessment with one of the Physiotherapists at Play On Pediatric Therapy in Ottawa, Ontario, and they will help advise you and guide you towards achieving your child’s functional goals.
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