Around 85% of the population walks either pigeon-toed or out-toed to some degree, so if you’ve noticed this in your child, you’re far from alone. What’s less well known is that, for many years, this was assumed to simply correct itself with age and in most cases, it doesn’t.

What Is Tibial Torsion?

Pigeon-toeing and out-toeing are both forms of tibial torsion – a twist in the shin bone (tibia) relative to the knee. Internal tibial torsion, also known as pigeon-toeing or in-toeing, occurs when the lower leg bone twists inward. External tibial torsion, or out-toeing, occurs when it twists outward. Pigeon toe can also occur as a result of tight groin muscles, while out-toeing is often associated with tight gluteal or external hip rotator muscles.

 

Why It Doesn’t Just “Correct With Age”

It was long believed that children with pigeon toes, out-toeing or flat feet simply grew out of these issues over time. In our clinical view, that’s a misunderstanding of what’s actually happening. It’s true that the visible position often appears to improve but once a child reaches around six years of age, the underlying torsion generally doesn’t correct any further on its own. What changes instead is that the body compensates.

 

How the Body Compensates

When a child has internal tibial torsion, the hip muscles – particularly the gluteals and the iliotibial band begin to tighten to help rotate the leg back toward a straighter-looking position, while the muscles on the front of the thigh (the vastus medialis oblique) can weaken. The opposite compensation occurs with external tibial torsion, where the inner hip muscles contract to help pull the foot straighter.

The result is that the visible walking pattern can look like it’s improved, while the underlying torsion is still there just masked by muscular compensation elsewhere in the leg. Over time, this compensation pattern can itself contribute to abnormal rotational stress at the knee joint, since the knee ends up working in a twisting motion rather than its normal hinge motion.

 

Our Approach

A biomechanical assessment is used to measure the actual degree of tibial torsion present, along with the compensation occurring through the hips, so we can determine whether and how treatment may help.

 

Treatment Options We Offer

For children who are still growing, specialised gait-plate orthotics can be used to encourage the shin bone to torsion in the required direction over time. This approach is aimed at addressing the underlying torsion directly, rather than only managing the compensation pattern around it with the goal of avoiding ongoing issues, including unnecessary rotational stress on the knees, later in life.

 

Frequently Asked Questions

Will my child grow out of pigeon toe or out-toeing?

In many cases, not fully while the visible walking pattern can appear to improve as the body compensates through the hips, the underlying torsion in the shin bone often remains. This is why an assessment before age six, while the bone is still developing, can matter.

Is this something I caused, or could have prevented?

No. Tibial torsion is generally a genetic, inherited trait rather than something caused by anything a parent did or didn’t do.

At what age should this be assessed?

Earlier is generally better, since treatment options such as gait-plate orthotics are most effective while a child is still growing.

 

Book an Assessment

If you’ve noticed your child walking with their toes turned in or out, book a biomechanical assessment at your nearest Dr Abbie Clinics location.

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