In-toeing, commonly referred to pigeon toeing, is an orthopedic condition in children. It causes the feet to turn inward while walking and running. This can be problematic when there is underlying weakness present, range of motion deficits, and tripping or falling. Without an X-Ray, it is difficult to assess where exactly the in-toeing is coming from. There are 3 possible locations- hips, tibia (shin bone), or feet. When the hips have muscular imbalances, in-toeing is very treatable. First, we want to make sure that the child does not have limits in their range of motion. Do they have the ability to turn their hips to a more neutral position? If the answer is yes, move on to strengthening. Strengthening the external rotators of the hips will help to turn out the legs and feet to a more neutral position. Here are some tried and true intervention ideas to help you reach this goal.
Correct W-Sitting, if Present
W-sitting is not always a problem, but if your child W-sits AND they in-toe while walking, correct this sitting position. W-sitting is making those hips get real comfortable in internal rotation, which can cause even more in-toeing. Better alternatives would be to sit criss-cross applesauce or side sitting. Toddlers and kids are very smart and will pick up a verbal cue very quickly. I usually say ”sit differently” and physically move the legs to a different sitting position. After several times of doing this, you will just be able to say ”sit differently” and the child will correct it by themselves. Other families in the past have used these verbal cues: ”princess posture”, “feet in front”, ”move your feet”. I don’t usually like to say ”fix your legs/feet”, because it has a negative connotation to it, and we want to keep it positive for every child.
This is an amazing activity to help the child strengthen in that externally rotated position. To teach them the first time, you may just be able to show them yourself what a frog jump looks like. If the child has a difficult time catching on, provide hand over hand assistance. I usually say ”feet out, arms in the middle” because our main goal is for the hips to be externally rotated. Once in a good frog position, help them jump up. This is a very strenuous exercise (for adults and kids), so keep this in mind if you can only get them to do a few reps. A great way to practice this is to put a puzzle at one spot, and the pieces about 4 feet away. Have them pick out one piece at a time, put it in their (or your) pocket, and take 2-3 frog jumps over to the puzzle. I pretend that we are frogs saving the puzzle pieces from the water!
Here is my favorite puzzle to use for toddlers who may tire quickly- Click here
Here is my favorite puzzle to use for toddlers who can get up to 8 reps- Click here
Here is my favorite puzzle to use for older toddlers/kids- Click here
Take a trip to the park and work on climbing the rock wall. It is very difficult to climb a rock wall unless the legs are externally rotated. If they still try to climb with their feet pointed in, help them turn the foot out before they place it on each rock. This also works on core strength and coordination, which may be beneficial for your in-toer as well!
This little horse is called Rody. He has been a recent favorite of mine to work on hip external rotation. Have the child sit, straddling Rody, and either bounce in place, or help them bounce forward to a toy. This is a good toy to take on a scavenger hunt. I like to use Mr. Potato Head. Hide all of his parts around the house or clinic when the child is not looking. Then use this script- “Oh no! The bad guys hid all of Mr. Potato Head’s parts! Now Mr. Potato Head can’t see, hear, or play! Let’s take Rody on a mission to save the day and find all of the parts that he needs.” Then you can hold Mr. Potato Head and when they find a piece, they can put it on him!
Tag me on facebook or instagram (pedsPTwithEmily) if you try any of these ideas and how successful they are!