In-toeing, also known as “pigeon-toes”, occurs when the feet point inwards when walking. Children with in-toeing may walk or run with one or both feet turned inwards. While it is not typically painful, in-toeing may result in children tripping and falling or struggling to achieve gross motor milestones. Children who use an in-toeing gait also may prefer to use W-sitting.

Common Causes

1. Metatarsus adductus

  • Curvature in the feet, resulting in the toes turning inwards.

2. Tibial torsion

  • A twist in the shin bones (tibias), resulting in the feet turning in. This is the most common cause of in-toeing for toddlers.

3. Femoral anteversion

  • A twist in the thigh bones (femurs), making the feet turn in. This is the most common cause of in-toeing in school-aged children.

How Physiotherapy Can Help

  • Physical assessment to determine the cause of in-toeing
  • Gross motor assessment to ensure motor milestones are being achieved
  • Strengthening exercises in neutral alignment
  • Positioning recommendations