Why do toddlers walk in-toeing?

Parents often ask, "My kid walks with inward-turned feet, can it be corrected?"

This condition is know as in-toeing or pigeon-toed where a child's feet turn inward instead of pointing straight ahead when standing, walking, or running.

So, how did in-toeing happens?

It's relatively common in toddlers and young children who are still adjusting to the best walking pattern and inward turning of the feet can happen either on the foot, shinbone, or thigh bone.

 

Metatarsus Adductus

In-toe condition due to foot, it is know as Metatarsus Adductus.  Metatarsus adductus is a condition where a baby's foot bends inward at the middle. It's like the foot has a curve or bend towards the inside, rather than pointing straight ahead.

This can happen because of how the baby was positioned in the womb or sometimes due to genetics.

Treatment for metatarsus adductus depends on the severity of the condition.

In mild cases, where the foot is flexible and can be easily straightened, no treatment may be needed as the foot often corrects itself as the child grows.

For more severe cases or if the condition doesn't improve on its own, doctors may recommend:

a) Stretching exercises: Exercises that gently stretch the foot and encourage it to straighten out over time.

b) Special shoes or braces: These are designed to gently guide the foot into a straighter position as the child grows.

c) Casting or splinting: In some cases, a doctor may use casts or splints to hold the foot in a straighter position for a period of time to encourage proper alignment.

d) Surgery: In very rare and severe cases where other treatments haven't been successful, surgery may be considered to correct the alignment of the foot.

With proper care, most children with metatarsus adductus can have normal foot function as they grow older.

 

Tibial Torsion

In-toe condition due to foot is known as Tibial Torsion. Tibial torsion is a condition where the shinbone (tibia) twists inward or outward, affecting the alignment of the leg. In simpler terms, it means that the lower leg bones are rotated, causing the feet to turn inwards (internal tibial torsion) or outwards (external tibial torsion) when standing or walking.

Internal tibial torsion is the condition that caused in-toeing. Tibial torsion usually occurs during fetal development or early childhood when the bones in the leg are still forming and growing. It can happen due to various factors:

a) Genetics: Sometimes, tibial torsion can run in families, suggesting a genetic predisposition to the condition.

b) Positioning in the womb: The position a baby adopts in the womb can affect how their bones develop. If the baby's legs are positioned in a certain way for an extended period, it might lead to tibial torsion.

c) Natural development: As children grow and their bones mature, it's not uncommon for the tibia (shinbone) to twist slightly as it develops. This twisting usually corrects itself over time as the child grows, but in some cases, it may persist and cause tibial torsion.

d) Muscle imbalances: Imbalances in the muscles around the leg can also contribute to tibial torsion. If certain muscles are tighter or weaker than others, it can affect the alignment of the bones in the leg.

Overall, tibial torsion is often a combination of genetic factors, developmental processes, and external influences on bone growth and positioning.

The treatment for tibial torsion depends on the severity of the condition and how it affects a person's ability to walk or move comfortably. Here are some common treatments:

a) Observation: In mild cases where tibial torsion doesn't cause significant problems, doctors may simply monitor the condition over time to see if it improves on its own as the child grows.

b) Stretching exercises: These exercises can help to loosen tight muscles and improve flexibility in the legs, which may reduce the impact of tibial torsion.

c) Orthotics or special shoes: These are designed to provide support and help correct the alignment of the feet and legs, reducing any discomfort or difficulty with walking.

d) Surgery: In more severe cases where other treatments haven't been effective and tibial torsion is causing significant problems, surgery may be considered. The surgery aims to realign the bones in the lower leg to improve stability and function.

With proper care, many people with tibial torsion can lead active and comfortable lives.

 

Femoral Anteversion

In-toe condition due to thigh bone is known as Femoral Anteversion. Femoral anteversion is a condition where the thigh bone (femur) rotates inward more than normal.

This means that the upper part of the leg, near the hip joint, turns inward more than it should, affecting the alignment of the leg and how the hip and knee joints function. It's like the entire leg is twisted inward from the hip down to the knee.

This can affect how a person walks, causing their knees and feet to turn inward as well. Femoral anteversion can happen during childhood as the bones are growing and developing, and it's often more noticeable during early childhood when children are learning to walk.

In most cases, femoral anteversion improves on its own as the child grows older and the bones mature, but in some cases, it may persist into adulthood and cause ongoing issues with walking and hip or knee pain.

It often becomes apparent between ages 3 to 6. This could be due to the lack of squatting in modern lifestyles. In the past, houses were equipped with squatting toilets, giving children the chance to practice squatting while using the toilet. But nowadays, most houses are equipped with sitting toilets, where children have fewer opportunities to engage in squatting movements daily.

Hence, extra effort needed to correct femoral anteversion. Myofascial release and sumo squat stretch can be performed on the inner thigh muscles to reduce the inward turning of the thigh bone in case of femoral anteversion. After the myofascial release, the child is advised to do a lot of squats to turn the thighbone outward.

The inner thigh and hip muscles are some of the largest muscles in the human body. It takes time to realign the thigh bone, and it could take more than 6 months depending on the severity of the condition and the frequency of treatment.

If your child still has an in-toeing condition after age 7 and you notice they have difficulty walking or running, it is advisable to seek intervention. Common symptoms include tripping or falling more often because their feet cannot effectively roll from the heel to the toe, and their knees and hips may not be able to flex in the direction of movement.

If nothing is done and the condition persists after age 7, it might reduce their ability to participate in sports or other physical activities as they grow older, potentially leading to frustration or decreased physical fitness. Some children might feel self-conscious or face teasing from peers, which can affect their self-esteem and social interactions.

We believe every child deserves to experience the joy of a carefree childhood, just like their parents did. That's why we're dedicated to helping children to improve their mobility through specialized gait training. 

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