Internal rotation in children: why do they walk with their toes pointing inwards?

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Philippe Gloaguen
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Internal rotation in children

Attending the first steps of your child is a very exciting experience but, since we parents are also very good at scrutinizing every move of the children with the lantern, every new experience can bring with it doubts or real anguish.

Well, here it is not only a father who speaks to you, but also a physiotherapist.

Today I will deal with the topic internal rotation (physiological), not to be confused with congenital clubfoot, which is a real pathology that can be highlighted in the newborn (correctable!).

In this article

  • First steps
  • Can it cause falls?

First steps

Some parents of younger children who have just started walking often come to me worried because their children they place their feet with the toes turned inwards. Nothing to fret about! This attitude, which at first may seem anomalous or even pathological, in fact it is absolutely normal.

What is the cause

Around the age of 2-3, children walk in the way just described. Although this attitude can be a source of anxiety for parents and relatives of children, one should not be alarmed in almost all cases.
The femur (from the Latin "femur" which means 'thigh') is the longest bone in the body and the only bone in the thigh. In the first years of life, the femur is internally rotated, therefore the child can only place his feet "pointing" them inwards. The femur, in order to maintain the erect position and allow walking, is forced to rotate inward, i.e. rotate around its longitudinal axis, in order to ensure the centering of the femoral head within the cavity of the acetabulum. Another factor that affects this attitude is tibial internal rotation, due to the fact that children walk with their knees slightly bent, and this causes the foot to "point" inward.
The path of a child, for various aspects including the musculature, differs widely from that of an adult and deserves more study, but at the moment I want to dispel useless, and equally legitimate, worries.

Read also: Flat feet in children

Can internal rotation cause children's falls?

I am also asked if internal rotation is the cause of the child's multiple falls. The answer is absolutely no: children fall, lose their balance, simply because their pace is still immature and rightly so.

Asking the child to walk better, to correct him continuously, does not make any sense, it could even be counterproductive also because it would stress him for something that he will acquire on his own over time, but surely there are positions, such as the "W" one said by the American "watching position", which certainly should be discouraged. But be aware that my two-and-a-half-year-old son often sits "W" too. It is clearly a very comfortable position at that age, which for the aforementioned reasons comes naturally, however it would be better to encourage a sitting position with the legs spread apart or "Indian style". What is certain is that correction devices, corrective footwear, and other therapies are not needed.

With the onset of walking and skeletal development, muscular tensions produce a progressive "unwinding" of the bones. Keep in mind that it takes nine months to "roll up" in the womb and a good nine years, approximately, to "unwind" after birth.

È in fact around the 9-10 years that the internal rotation of the femur disappears definitively and it is towards i 14-15 that there will be a physiological external rotation that will accompany us throughout adulthood. This intra-rotatory attitude during walking is observable, for the most attentive, even in older children.
The complete maturation of the journey takes place slowly and it can be said that walking well alone, as they say "with your own legs", requires patience even from a purely physiological point of view!

On the author of the article, Luca Zecchini

Luca Zecchini, Doctor of Physiotherapy, specialized in manual therapy and musculoskeletal physiotherapy.
Certified Orthokinetic Physiotherapist
US member on the GSTM column

Read also: Why avoid the "fly fly" game

  • first steps
  • piedi
  • baby feet
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