• Feet / toes point inward when walking

 • In-turned legs

 • Often is in association with flat or over-pronated feet

 • Often more pronounced at end of day when feeling more tired

 • Increased incidence of trips and falls

 • Sits in “W” position

 • Onsets between 1.5 and 2.5 years of age for children

 • Self corrects in milder cases by age of 5 for children

 • Can be seen as a result of intrauterine “packaging” of family history

Often seen in children and adults with connective tissue disorders including Be-nign Joint Hypermobility, Ehlers Danlos Syndrome, Marfans and Downs Syndrome. If not self corrected by 5 years of age, can be a combination of femoral and tibial torsion involved. This foot position is also seen in some children with Cerebral palsy (CP) and one-sided with spastic diplegia or spastic hemiplegia

Possible Causes

 • Femoral anteversion (hip internal rotation > 70 degrees)

 • Ligamentous laxity of hips and associated muscle weakness

 • Medial tibial torsion

 • Metatarsus adductus (forefoot deformity)

Non-Surgical Management Options 

 • Core and pelvic stability exercises

 • Strengthening of pelvic and hip musculature

 • Proprioceptive exercises

 • Spiral Thigh Brace™ for biofeedback and gait re-education worn for 4-5 hours a day for a period of 3-6 months or as indicated by health professional

 • Customised orthotics for correction of foot deformities

In cases when femoral anteversion or ligamentous laxity of the hips or CP are causes of the pigeon toe walking then the Spiral Thigh Brace is an excellent therapy tool. People are often prescribed strengthening exercises for the lower limb in an attempt to improve the pattern of walking. Despite strengthening the muscles, gait patterns often remain unchanged due to ingrained motor patterns , adaptive changes and posturing. The child or adult often has no memory or concept of what it feels like to walk in a different or more normalised pattern . The Spiral Thigh Brace is a fantastic biofeedback tool to facilitate motor learning and development of new motor memories to help the body and brain to learn to walk in a more normalised pattern. Like an exoskeleton, the Spiral Thigh Brace is body hugging and allows freedom of movement while controlling the direction of movement. Click here to find out more about the Spiral Thigh Brace.

 • Femurs internally rotated

 • Patella inturned in gait

 • +/- inward turning of tibia and feet

 • Excessive rotation of pelvis in stance and swing phase of gait

 • Knock-knees / inturned legs in conjunction with pigeon toes

 • Femoral anteversion (hip internal rotation > 70 degrees)

 • Ligamentous laxity of hips causing excessive internal rotation of hips and thighs with associated weakness of pelvic and hip muscles

 • Genu valgus

 • Core and pelvic stability exercises

 • Strengthening of pelvic and hip musculature

 • Proprioceptive exercises

 • Spiral Thigh Brace™ for biofeedback and gait re-education worn for 4-5 hours a day for a period of 3-6 months or as indicated by health professional

 • Customised orthotics to avoid overuse of feet and encourage control of movement from the pelvis and lower trunk.

Click here to find out more about the Spiral Thigh Brace.

 • Excessively turned out feet (duck feet)

 • Often delayed walker

 • Often in association with flat feet

 • Reduced hip movement in swing phase of gait

 • Commonly decreased lumbar lordosis in standing

 • Hips and lower trunk slightly flexed in gait

 • Weakness in pelvis including gluteus medius and weak core muscles

Walks and runs with heavier, awkward looking run with poor push-off. Tires quickly when running and may avoid weight-bearing sports. Often seen in children with endomorph shape and coexisting hypermobility. Often seen in association with coordination difficulties.

 • Femoral anteversion with external tibial torsion (inturned hips and out-turned lower legs)

 • Femoral retroversion, tight hip external rotator with tibial torsion (out-turned hips and lower legs)

Femoral Retroversion

 • Stretching of external rotators of the hips

 • Avoid sleeping prone. Night splinting for prolonged stretching

 • Core and pelvic stability exercises

 • Strengthening of pelvic and hip musculature

 • Gait re-education

 • Customised orthotics

Femoral anteversion with external tibial torsion

 • Proprioceptive activities

 • Spiral Thigh Brace™ for gait re-education and biofeedback

 • Core and pelvic stability exercises

 • Strengthening of pelvic and hip musculature

 • Gait re-education

 • Customised orthotics

Click here to find out more about the Spiral Thigh Brace.

Increased neurological tone and/or spasticity in the lower limbs is a cause of toe waking. The spasticity in the legs can cause the calves to tighten and reduce in length, forcing the feet into a plantar flexed (pointed position). The tightness in the calves reduces child’s ability to rest heels on the ground. In addition children with CP often have very weak muscles in the lower limbs making walking with the correct muscles very difficult. Sometime the child will use the increase tone to their advantage by way of using the toe walking as a adaptive walking pattern. Tip toe walking is an adaptive walking pattern to allow the child to loco mote despite weak pelvis muscles and tonal changes.

Children with hypermobility often have ligamentous laxity in the hip/knee/ankle joints. In association with this it is quite common for the proximal muscles (core/pelvis/hip) to be weak and the longer distal muscles (hamstrings /calves ) to be strong. They are unable to stabilise or control movement efficiently due to weakness around the pelvis and thus overuse the calf muscles as an adaptive mechanism to facilitate walking.

There is a higher incidence of hypermobility and ligamentous laxity in the ASD population in comparison to the normal population. Like the hypermobile group, weakness in the trunk and and pelvis predispose child to overuse of the calves and hamstrings and thus tip toe walking.

 • Child walks on tip toes with heels raised off floor

 • Gastroc-soleus (calf muscles) muscles often look well developed

 • Decreased length of gastroc-soleus +/- hamstrings

 • Foot changes due to abnormal weight bearing ( fan shaped forefoot or flat over pronated foot or pes cavus)

 • Weakness in hip and bottom muscles

 • Often have weakness in core muscles

 • May complain of calf or shin pain

 • +/- increased tone in lower limbs ( in cases of cerebral palsy)

Non-Surgical Management Options 

 • Stretching of tight muscles groups

 • Strengthening of pelvis muscles (especially gluteus medius and quadriceps) and core stability muscles

 • Botox ( in cases where increase tone is a cause)

 • Spiral Thigh Brace™ for gait retraining

 • +/- Orthotics from a podiatrist to reduce overuse of ankle foot and stabilise foot so that child is encouraged to use hip muscles to control movement and balance as opposed to using tip toes

A child who has tip toed since they started to walk and has maintained the pattern for years, often has no memory or concept of what it feels like to walk in a different or more normalised pattern . The Spiral Thigh Brace™ is a fantastic biofeedback tool to facilitate motor learning and development of new motor memories to help the body and brain to learn to walk in a more normalised pattern. Like an exoskeleton, the Spiral Thigh Brace™ is body hugging and allows freedom of movement while controlling the direction of movement.

Click here to find out more about the Spiral Thigh Brace.