From the Guidelines
Toes pointing towards the midline in adulthood, known as in-toeing or pigeon-toed gait, typically doesn't require treatment unless it causes pain, functional limitations, or frequent tripping. The provided evidence [ 1 ] focuses on the prevention of foot ulcers in persons with diabetes, which is not directly related to the treatment of in-toeing in adulthood. However, it emphasizes the importance of proper foot care and footwear in preventing foot-related issues. For mild cases of in-toeing without symptoms, no intervention is necessary. For symptomatic cases, I recommend starting with:
- Supportive footwear with proper arch support
- Possibly custom orthotics to help realign foot positioning
- Physical therapy focusing on strengthening and stretching exercises for the hip rotators, hamstrings, and foot muscles to improve alignment and gait mechanics. In some cases, night splints may help gradually reposition the feet. The underlying causes of persistent in-toeing in adults include femoral anteversion (inward rotation of the thigh bone), tibial torsion (twisting of the shin bone), or metatarsus adductus (curved foot), which can affect how weight is distributed across the feet and joints during walking, leading to compensatory movements throughout the kinetic chain [ 1 ]. Surgery is rarely indicated but might be considered in severe cases causing significant pain or functional impairment. Most adults with mild to moderate in-toeing can manage effectively with conservative approaches focused on proper footwear and targeted exercises.
From the Research
Toes Towards Midline Adulthood
- The provided studies do not directly address the topic of "toes towards midline adulthood" [@@].
- However, some studies discuss toe walking, which may be related to the topic.
- According to a study on toe walking, the prevalence of toe walking at age 5.5 years is 2% in normally developing children, and 41% in children with a neuropsychiatric diagnosis or developmental delays [@\2@].
- Treatment for toe walking is based on age, underlying cause, and the severity of tendon contracture, and may include casting, chemical denervation, orthotics, physical therapy, and surgical lengthening of the gastroc-soleus-Achilles complex [@\2@].
- Another study reviews the literature on idiopathic toe walking, including its etiology, prevalence, classification, and treatment [@\5@].
- The use of botulinum toxin type A has been studied as a treatment for spasticity in children with cerebral palsy, which may be related to toe walking [@\1@, @\3@, @\4@].
- These studies suggest that botulinum toxin type A can be effective in reducing hypertonia and improving function in children with cerebral palsy [@\1@, @\3@, @\4@].