In Toe Walking

Now that it’s summer, I see a lot more kids and adolescents playing outdoors. I was amazed at the number of children I have seen walking with toes pointed in! Let’s understand more in details of what it is and how it affects children as they grow.

Firstly, what is a normal hip joint?

The Hip joint is one of the most important and strongest joint of the body which bears body weight and plays a major role in our daily activities. It is a ball and socket joint wherein the ball of femur (bone between hip and knee) moves within the pelvic socket called Acetabulum. It is a stable joint with supporting structures providing inert support and minimizing friction, making it pain free and without problems in majority of people through their lifetime.

Now let’s figure out what is Femoral Anteversion?

Femoral Anteversion is inward twisting of femur (thigh bone). In toddlers and children (younger than 7yrs), walking with feet slightly turned in, is normal part of their hip alignment. Their legs start to straighten once the baby learns to weight bear on their feet and walk (by around 9-12 months) and reach normal adult range by 7 years of age. Excessive inward twisting beyond this age causes your child’s knees and feet to turn in giving a pigeon toed appearance or in toeing gait (walking pattern).

What causes Femoral Anteversion?

Although the exact cause is unknown, it is believed to be a consequence of a child’s developmental habits. When the child is first learning to sit, it’s easier for a child to do so in “W” sitting as it is favoured by natural hip position, broad base and lesser use of core muscles.

What   signs and symptoms should you look out for?

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Child walks with knees and foot turned in (In toeing)








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Awkward running pattern where foot swings out during running



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Preferred W sitting as a child or uses it through adolescence





In addition, a child may complain of pain around his/her hip, knee or ankle; frequently lose balance or find it difficult to engage in outdoor sports like skating, hockey, soccer which put a demand on child’s dynamic balance.


How can Physiotherapy help?

 Although, it is commonly the parents and caregivers who notice these signs and symptoms in their child, I have also come across adolescents who would approach parents with these concerns. Parents, caregivers or adolescents are always encouraged to see a physician or physiotherapist regarding their symptoms and get a thorough assessment.

During examination, the child may commonly demonstrate decreased range in outward turning of hip (external rotation) and backwards (extension) with weakness of hip, knee and ankle muscles. Many may commonly exhibit lower strength in core abdominal and back extensors.


Even if Physiotherapy may not completely change the structure of hip joint specially if the child is post skeletal maturity age (varies from child to child, but on an average around mid-teens),  it definitely helps to control the progress of hip turning-in and brings about significant changes in child`s function.


Physiotherapy is generally aimed at:

  • Improving range at hip
  • Strengthening hip, knee, ankle muscles
  • Building up core strength of abdominals and back extensors
  • Improving or maintaining trunk and lower limb alignment through use of Specialized Orthotic Garment Systems


It`s always best to be alert and act promptly, than be late and sorry


Written by Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)

Book an Appointment to have your Child evaluated with me at this Downtown Toronto Clinic