17/10/2025
Derotational techniques are used to help intoeing by encouraging bones and joints to align correctly, promoting a straighter gait. Intoeing, or pigeon-toed walking, is when the feet point inward rather than forward.
How derotation helps intoeing
Derotational approaches are designed to address the underlying cause of the intoeing, which is an internal twist or rotation in the legs. The specific method used depends on whether the rotation originates in the feet, shins, or hips.
Common causes of intoeing
Metatarsus adductus: The front of the foot is curved inward. This is common in infants and usually resolves on its own.
Internal tibial torsion: The shinbone is twisted inward. This typically appears in toddlers and often corrects itself by school age.
Femoral anteversion: The thighbone is turned inward at the hip. This is most noticeable in children aged 3 to 6 and typically improves with growth.
Derotational methods and their role
Orthotic devices (for metatarsus adductus)
In some cases of metatarsus adductus where the foot is rigid, doctors may use a series of casts or special shoes for infants to stretch and correct the foot's position. This is the exception for bracing, as braces are generally ineffective for intoeing caused by tibial or femoral rotation.
For older children, gait plates, a type of foot orthotic, can be used. These custom insoles extend past the fifth toe, making an inward-pointing foot strike uncomfortable and encouraging the child to walk with the toes straighter.
Physical therapy and exercises (for femoral and tibial issues)
In children, the goal is often to strengthen the muscles that promote outward rotation of the hips. Fun exercises can be used to make this process engaging.
Example exercises include:
Penguin walk: Walking with the heels together and toes pointed outward.
Side-stepping: Moving side-to-side like a crab.
"W"-sitting modifications: Avoiding this sitting posture, which can exacerbate femoral anteversion.
Surgical derotation (for severe cases)
For older children (typically over 8 to 10 years old) with severe, persistent intoeing that causes significant functional problems like tripping or gait abnormalities, a procedure