Commonly referred to as being “pigeon toed,” in-toeing is
when a child walks with his or her feet turned inward.  In-toeing can cause a child to seem more
clumsy, demonstrate poor balance, and to trip and fall more frequently than
peers.  The cause of in-toeing can be the
result of a few different factors.


In-toeing can be due to the ankles and/or feet
themselves being curved inward.

In-toeing can be the result of tibial torsion where the
bones in the calves twist inward causing    the feet to appear to turn inward when

In-toeing can be the result of femoral torsion where
the long bones of the thigh twist inward causing the knees and feet to point

In-toeing can also be the result of shortened muscles
in the ankles or hips.


As mentioned in last month’s blog on W-sitting, when
children sit in a W this can result in shortened muscles in the hips which can
lead to in-toeing.  Children who
chronically sit in a W create excessive range of motion in their hips in one
direction, while also creating a decreased range of motion in their hips in the
opposite direction.  This imbalance in
the muscles surrounding the hips can make them very tight and can cause the
entire leg to turn inward.


A physical therapist can help by assessing a child to
determine which of these problems are causing the in-toeing.  Depending on the cause of the problem a
physical therapist will recommend the proper course of action, which may

Orthotics for proper positioning of the feet and ankles.

Stretching for tight muscles.

Strengthening for weak muscles.

De-rotation bands, which are elastic bands that help
reposition in the legs in proper alignment.

Eliminating W sitting in favor of sitting in


By Laurel Johnson, DPT