What is in-toeing? As walking develops, you may notice a tendency for your child’s toes to turn in, or point inward. This may result in their walking appearing very clumsy or frequent tripping. This often raises concern in parents and is a common topic of discussion.
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The first thing to do is take a deep breath, and know that as your kiddo’s skeletal system grows and develops it is very normal to see this kind of rotation happen. Bones, and bony protrusions all grow at different rates, and your kiddo’s skeletal system undergoes a lot of change in the first 5-6 years of life. Even better, according to the literature, most of these issues should spontaneously resolve by age 6-7. In fact, the current practice is conservative, meaning the doctor will likely recommend you “wait and see”.
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Here’s an example of a kiddo, aged 2 who demonstrates a tendency for her toes to point in when walking.
The research for specific exercises and conservative management is lacking in this area, however with knowledge of development and mechanics we feel that there are definitely some steps you can take to encourage proper development and quality of walking. For Coco, her mom (our PT Rhea), decided to integrate some ideas and purposeful play into her routine to help nudge her in the right direction.
In this article we will be sharing some general guidelines and ideas you can try with your child to help encourage proper development and alignment. These are meant to be playful! Never force your kiddo to perform these activities if they are uninterested or not motivated by them.
Note:
This is not intended to serve as “skilled Physical Therapy intervention or medical treatment in any way”, rather the ideas in this article are intended to serve as general wellness guideline and ideas for purposeful play for children who are demonstrating typical development. Always discuss concerns with your child’s pediatrician and it is highly encouraged that you visit your pediatrician as well as inquire about Physical Therapy Intervention if:
- Your child is significantly behind in gross motor milestones.
- Your child is not walking by 18 months.
- You notice “asymmetries” (sides of the body working differently)
- Your child is >2 years old and struggles significantly with getting up from the floor, going up and down stairs, and/or jumping.
If you have questions or concerns, feel free to send us a message and we’ll do our best to steer you in the right direction and recommend the right person to see. Your child’s pediatrician is the best starting place for concerns regarding gross motor development.
Step 1: Supportive shoes
With children ages 2-4, it’s important to find shoes with a good balance between being supportive, but not to rigid or intrusive. Look for a small arch support, relatively flexible shoe, and one with a stiff heel cup. It’s also very important to find a shoe that is lightweight so that your child is able to clear the floor and control their joints with less energy expended. .
We highly recommend you check out Wobbly Waddlers. We recently tried their shoes and they have been a game changer for Coco’c walking and willingness to jump and explore. Here are some recommendations:
Note: If you notice your child’s arch in their foot is dropping or “collapsing” when standing or walking after the age of 1 year old, you will want to discuss more supportive options with a Physical Therapist or Podiatrist.
Step 2: Limit W Sitting
If your child has a preference to sit on their legs, or if their legs form a “W” when sitting, you may want to try to discourage this position. Theoretically, this position can and may exacerbate the rotations of the long bones in the leg and may contribute to in-toeing for a prolonged time.
Here are some Simple Strategies to address and Discourage W Sitting.
Step 3: Let’s get those legs working!
One of the most simple exercises you can encourage your child to do during play is squats! To get your kiddo working on squats, take the motivating toy/activity and place it on the floor. Click to see our post on toy placement.
Step 4: Integrate Balance Challenges into Play!
Did you know that 60% of our walking cycle is spent on one leg? Cool, right?
Practicing and encouraging play that involves balancing on one leg is a great way to work on improving walking quality as well as overall development with gross motor skills.
Doing activities while balancing with one foot on a raised surface is a great starting point. The higher the surface, the more challenging.
Watch how Coco’s left leg is working hard while trying to get the sticker on the paper.
Another silly option is to place stickers on your kiddo’s knee or foot (more difficult), and ask them to lift their leg up to get it.
Always try on both sides. Check out the face of “success”!
Stepping over obstacles is a great and functional way to work on this skill. Get creative and build your kiddo an obstacle course. You can get hurdles, or use everyday household items like towels, shoe boxes, pool noodles, etc.
Step 5: Strengthen Intrinsic Foot Muscles
The arch of the foot starts to form and develop within the first 2-3 years of our life. Intrinsic foot muscles help to support that arch. Letting your kiddo move and explore barefoot has great benefit. Here are some play ideas you can encourage your child to participate in that will help strengthen the foot.
Bubble wrap is always motivating! Encourage your child to stand on it and squeeze it to hear the satisfying “pops”!
Picking up Pom Poms or cotton balls with your feet. If balance is a challenge you can do it in a seated position.
Pick up items in standing. Here Coco is picking up her laundry and putting it in the basket! This also helps with single leg balance.
Watch those feet and ankle muscles fire on a balance bridge. Here are some recommendations on balance bridges.
Step 6: Work on Control!
Walking is often referred to as “controlled falling”. When babies and toddlers first learn to walk they do more of a side to side waddle. As they start to get faster and braver, you often start seeing more trips and falls, as they are working hard to control their forward progression.
You can see here as Coco walks, how she’s working to control her forward progression. You can also hear her feet slapping the ground abruptly. As walking develops and starts to look more “adult-like”, we gain much better control of this.
Here are some ideas for providing opportunities to work on the natural development of this control.
- Walking/running on hills, specifically downhill.
- Beach or sand walking/running.
- Step ups/downs: This can be done on stairs or as part of an obstacle course.
- Heel walking: Have your child practice lifting their toes and walking on heels.
Being silly and practicing running down a hill is a great way to kick in these muscles.
Walking and running on the beach or similar sandy areas is a great way to strengthen.
Step 7: Target Core and Hip Strengthening Through Play!
- jumping activities work on strength and power. 2-foot jumping and jump squats target,
-sidestepping and backward walking targets hip/glute muscles that help control the long bone (femur) in our legs,
- Practice backward walking for fun and add it to an obstacle course. It you can do it barefoot, that’s a plus!
- Bear crawls are a great way to target the core Here you’ll see a very young Coco learning how to bear crawl on bubble wrap!
Perform activities recommended by Walk, Talk, Play at your own risk with appropriate adult supervision provided. Walk, Talk, Play is not responsible for any injury caused while performing these play activities.
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