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.

Common Causes

1. Metatarsus adductus: Curvature in the feet, resulting in the toes turning inwards. This usually occurs over the first four to six months of life.

2. Tibial torsion: A twist in the shin bones (tibias), resulting in the feet turning in. This can occur before birth and typically improves without treatment and before school age due to growth.

3. Femoral anteversion: A twist in the thigh bones (femurs), making the feet turn in. It is most obvious at five to six years of age. Children with tibial torsion typically adopt a “w” sitting position.

How Physiotherapy Can Help

• Reducing “w” sitting
• Exercising in good alignment
• Referral for braces and shoes that can complement treatment
• Assessing for severe in-toeing — surgery may be implicated