How to Correct In-Toeing: Tips for Rehabilitation and Improvement

Internal rotation of the feet (also known as "in-toeing" or "pigeon-toed

Hello, doctor.
I have had an inward toeing issue since childhood, but my parents said it was due to my walking habits and that it would improve as I grew up.
However, now that I am older, I find that the inward toeing still exists, with my left foot being more pronounced than my right.
Often, when I walk, my left foot tends to cross over my right foot (I can sit cross-legged).
The anterior superior iliac spine on my right side is more prominent than on my left, and when both legs are straightened, my left ankle shows a significant inward rotation, while my right ankle has only a slight inward rotation.
I would like to ask: 1.
What can be done to improve the inward toeing issue, so that I won't trip over myself while walking?

Xiao Hou, 10~19 year old female. Ask Date: 2017/02/16

Dr. Su Hongci reply Rehabilitation

During fetal development, the lower limbs gradually flex to adapt to the confined space of the uterus.
Generally, the calves exhibit noticeable internal rotation and bending, while the hips are in a flexed and externally rotated position.
After birth, as long as the pressure is relieved, most children can return to normal by the age of 8.
If this does not occur by age 8, it is advisable to consult an orthopedic specialist to assess for any skeletal abnormalities before proceeding with treatment.
Wishing you good health!

Reply Date: 2017/02/16

More Info

In-toeing, commonly referred to as "pigeon-toed," is a condition where the toes point inward while walking or running. This can be a result of various factors, including structural issues in the bones, muscle imbalances, or even habits developed during early childhood. It’s important to understand that while many children outgrow this condition, some individuals may continue to experience it into adulthood, as you have described.

Understanding In-Toeing
In-toeing can be caused by several anatomical factors:
1. Femoral Anteversion: This occurs when the femur (thigh bone) is rotated inward. It is more common in children and usually resolves as they grow.

2. Tibial Torsion: This refers to the inward twisting of the tibia (shin bone) and can also be a contributing factor.

3. Metatarsus Adductus: This is a condition where the front part of the foot is turned inward, which can affect walking patterns.

In your case, it seems that the left foot is more affected than the right, which may indicate a more pronounced structural issue or muscle imbalance. The asymmetry you mentioned, with the right iliac crest being more prominent, could suggest a compensatory mechanism in your body due to the in-toeing.

Rehabilitation and Improvement Tips
1. Consult a Specialist: Before starting any rehabilitation program, it’s crucial to consult with a healthcare professional, such as a physical therapist or orthopedic specialist. They can assess your specific condition and provide tailored advice.

2. Strengthening Exercises: Focus on strengthening the muscles around your hips and legs. Exercises that target the hip abductors and external rotators can help improve alignment. Some effective exercises include:
- Clamshells: Lie on your side with your knees bent and feet together. Lift your top knee while keeping your feet together, then lower it back down.

- Side Leg Raises: Stand or lie on your side and lift your leg straight up, keeping it in line with your body.

- Hip External Rotations: Sit with your feet flat on the ground and knees bent. Place a resistance band around your knees and push your knees outward against the band.

3. Stretching Exercises: Stretching the muscles that may be tight can help improve your range of motion. Focus on:
- Hip Flexor Stretches: Kneel on one knee and push your hips forward to stretch the front of your hip.

- Hamstring Stretches: Sit with one leg extended and reach toward your toes to stretch the back of your thigh.

4. Footwear: Ensure you wear supportive shoes that provide proper alignment. Avoid high heels or shoes that exacerbate the inward rotation of your feet.

5. Gait Training: Work on your walking pattern. A physical therapist can help you with gait training exercises to promote a more neutral foot position while walking.

6. Balance and Coordination Exercises: Activities such as yoga or tai chi can improve your overall balance and body awareness, which may help in correcting your walking pattern.

7. Use of Orthotics: In some cases, custom orthotics may be recommended to provide additional support and help correct foot positioning.

8. Regular Monitoring: Keep track of your progress and any changes in your symptoms. Regular follow-ups with your healthcare provider can help adjust your rehabilitation plan as needed.

Conclusion
In-toeing can be a complex issue, but with the right approach, it can be managed effectively. By focusing on strengthening, stretching, and proper gait mechanics, you can improve your walking pattern and reduce the risk of tripping or stumbling. Remember, consistency is key, and working closely with a healthcare professional will provide you with the best outcomes.

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