Understanding In-Toeing

What Is In-Toeing?
In-toeing, sometimes called “pigeon-toeing,” is when a child’s feet turn inward while standing, walking, or running. It’s a common concern parents notice in toddlers and preschoolers. In-toeing can arise from different areas of the leg or foot, including the hips, shins, or feet. While many children outgrow in-toeing naturally, persistent inward turning can affect balance, coordination, and walking patterns. Pediatric physical therapy can help identify the cause and support proper alignment, strength, and functional movement.

Who Does In-Toeing Affect?
In-toeing is fairly common in young children and can affect both boys and girls equally. It often becomes noticeable when children begin walking independently.
There are three main types:
Metatarsus Adductus: The front of the foot curves inward. Most common in infants and often improves without intervention; Often a positional issue in the womb, leading to a curve in the front of the foot.
Tibial Torsion: A twist in the shinbone (tibia) that causes the feet to point inward. Common in toddlers and usually resolves with growth; Frequently develops in toddlers due to natural growth patterns. Children may sit in the “W” position, which can reinforce inward rotation.
Femoral Anteversion: An inward rotation of the thigh bone (femur). Often seen in preschoolers and may persist longer than other types; Commonly develops as a child grows, usually peaking around age 3–5.

When to Seek Evaluation
Most cases of in-toeing are harmless and improve naturally. However, it’s important to consult a pediatric physical therapist if your child:

• Trips or falls frequently,
• Has difficulty running, jumping, or playing sports,
• Shows inward feet past early childhood,
• Experiences pain in the feet, knees, or hips

How Pediatric Physical Therapy Can Help
Pediatric PT can:
● Assess the Cause of In-Toeing Determine whether the inward turning is coming from the
feet, shins, or hips.
● Improve Strength and Alignment Strengthening leg, hip, and core muscles supports
proper walking and running patterns.
● Enhance Balance and Coordination Activities such as hopping, balancing, and obstacle
courses improve motor skills.
● Teach Proper Foot Positioning Exercises encourage the feet to point forward naturally.
● Provide Home Exercise Programs Parents learn fun and safe exercises to reinforce PT
goals at home.

Examples of PT Activities for In-Toeing
● Balance Games: Walking along lines or curbs, standing on one foot, or hopping through
an obstacle course.
● Stretching Exercises: Gentle stretches for the hips, legs, and feet.
● Strengthening Activities: Squats, bridges, or resistance-band exercises designed for
children.
● Gait Practice: Encouraging proper foot placement through playful activities like “follow
the leader” or running games.

Why Early Evaluation Matters
Early assessment and intervention help:
● Prevent persistent gait abnormalities
● Improve coordination and confidence
● Avoid discomfort or pain in the feet, knees, or hips
● Support age-appropriate motor skill development

With timely evaluation and guidance from a pediatric physical therapist, many children with
in-toeing achieve improved alignment and movement patterns, often without the need for braces or surgery.

If you have concerns about your child’s walking pattern, please call either of our offices or fill out the contact form on our website. Our team is here to provide a personalized evaluation and help your child move confidently!