How To Fix Pigeon Toe

What is Pigeon Toe?

Pigeon Toe is a postural issue where the feet point inwards.

This can be observed whilst walking or in the standing position.

Ideally – the feet should be pointing forwards/slightly outwards.

(It is also referred to as In-Toeing.)

How to tell if you have it

Not sure if you have Pigeon Toe? Try out this quick test!

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a) Test for Pigeon Toe

Instructions:

• Stand up.
• March on the spot for 5 seconds.
• Stop.
• Look down at your feet.

Which direction are your feet pointing towards?

Results: If your feet are pointing inwards, then you have Pigeon Toed feet.

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Is it bad?

With the inward turning of the feet, there is a loss of the ideal alignment of the lower limb.

As a result – the joints and muscles in the leg may not function optimally. (especially during gait!)

(Note: The presence of Pigeon Toe does not necessarily mean that there will be direct issues associated with it. The body can adapt!)

(Note 2: Those of you who are concerned with Pigeon Toed feet in children/toddlers, this will generally improve with time without surgery.)

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What causes Pigeon Toe?

It is important to know which exact area of the body is leading to the in-toeing presentation of your feet.

(This will determine the specific exercises that you will need to focus on in the exercise section down below.)

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Here are the 5 main causes:

1. Internal Rotation of the Hip

This refers to the inward twisting of the thigh bone (Femur) within the hip socket.

This movement may occur as a compensation for general weakness in the lower limb.

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How to tell if you have this issue:

Instructions:

• Stand up.
• March on the spot for 5 seconds.
• Stop marching.
• Look down at your knees.

Results: If your knees are facing inwards, then your hips are internally rotated.

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Muscles that need to be addressed

If your hips are internally rotated – you will need to specifically address the following muscles as shown in the exercise section of this blog post.

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a) Tight muscles:

(The following muscles INTERALLY ROTATE the hip.)

• Adductors
• Anterior Gluteus Medius
• Anterior Gluteus Minimus
• Tensor Fasciae Latae

b) Weak muscles

(The following muscles EXTERNALLY ROTATE the hip.)

• Gluteus Maximus
• Posterior Gluteus Medius
• Piriformis
• Deep posterior hip muscles

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(Note: Internal Rotation of the Hip can also lead to another postural issue called Knock Knee. This is where the knees are pointing inwards.)

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2. Internal Rotation of the Tibia (Internal Tibial torsion)

This refers to the inward rotation of the shin bone (Tibia) relative to the upper leg bone (Femur).

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How to tell if you have this issue:

Instructions:

• Identify the middle of your knee.
• Identify the midline of the Tibia.
• Are they aligned?

Results: If the line of the tibia is positioned towards in the inside of the knee, then your Tibia is internally rotated.

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Muscles that need to be addressed

If your Tibia is internally rotated – you will need to specifically address the following muscles as shown in the exercise section of this blog post.

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a) Tight muscles:

(The following muscles INTERNALLY rotate the Tibia.)

• Popliteus
• Medial Hamstring

b) Weak muscles

(The following muscles EXTERNALLY rotate the Tibia.)

• Lateral Hamstring
• Vastus Lateralis
• Lateral Gastrocnemius

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3. High Arched Foot

A high arch in the foot is characterized by having a more pronounced curve in the medial arch of the foot.

In some people – the high arch can lead to the middle of the foot curving inwards.

This can give the appearance of the in-toed foot position.

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How to tell if you have this issue:

Instructions:

• Stand up.
• Take a photo of the medial (inner) side of your foot.
• Observe the shape of the arch.

Results: If you can observe a prominent arch in your foot, then you have High Arches.

Muscles that need to be addressed

If you have High Arches – you will need to specifically address the following muscles as shown in the exercise section of this blog post.

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a) Tight muscles:

(The following muscles lift the arch in the foot.)

• Tibialis Posterior
• Flexor Hallucis Longus
• Flexor Digitorum Longus
• Plantar muscles
• Tibialis Anterior

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Structural issues

The following causes will NOT be addressed in this blog post:

4. Metatarsus Adductus

This abnormal position of the feet in babies is due to the feet being squashed in the womb.

It will usually self resolve within 4-6 months.

In severe cases – it can be treated with casting or special shoes.

5. Femoral Anteversion

This involves the angle between the femoral head and femur body being more narrower than normal.

As a result – the leg (including the feet!) turns inwards to better position the femoral head in the hip socket.

As this is a structural issue, there will be a limit as to how much the position of the leg can be changed.

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Exercises to Fix Pigeon Toe

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start Here: Determine the SPECIFIC AREA that your Pigeon Toe Is originating from.

To determine this – read the CAUSES OF PIGEON TOE in the section above.

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A. Hip Internal Rotation

Release Internal Rotators

Note: When applying the following releases, do not apply too much pressure as there are nerves and arteries that run through this area.

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a) Release with Foam Roller

(Target muscles: Anterior Gluteus Medius/Minimus, Groin muscles)

Instructions:

• Lie down on the stomach.
• Place a foam roller underneath the groin or front of hip region.
• Completely relax this leg.
• Apply an appropriate amount of your body weight on top of the foam roller.
• Roll up/down.
• Make sure to cover the entire muscle that is being targeted.
• Continue for 2 minutes.
• Repeat on the other side.

b) Self Release

Instructions:

• Sit on the edge of a chair.
• Drop your knee towards the side.
• Use your finger tips, knuckles or elbow to apply pressure to the groin.
• Continue for 2 minutes.
• Repeat on the other side.

Joint Mobilization

A stiff hip joint that is locked into the internally rotated position will need be loosened up via the following Hip Traction techniques.

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a) Traction in Neutral

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Wrap the other end of the band around the ankle. (See above)
• Move your body away from the anchor point until there is a firm amount of tension on the band.
• Lie down.
• Relax your entire body.
• Allow the resistance band to pull on your hip joint.
• Aim to feel a pulling sensation around your hip.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

b) Traction in Hip 90 Degrees flexion

Instructions:

• Anchor a thick resistance band to a stationary object.
• Loop the other end of the resistance band as close to the hip crease as possible.
• Flex and hold your hip to ~90 degrees.
  • Hold onto the back of your knee with your hands.
• Move your body further away from the anchor point to create a firm amount of tension on the band.
• Keep the hip completely relaxed.
• Hold this position for 1-2 minutes.
• Progression: If able – start to pull your hip into more flexion.

Stretch Internal Rotators

Here are 4 effective ways to stretch the tight internal rotators of the hip.

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a) Lunge

Instructions:

• Assume the lunge position.
• Point the foot at the back towards the outside.
• Lunge forwards as far as you can.
• Do not rotate your pelvis. Keep your pelvis facing the front.
• Aim to feel a stretch in the groin region.
• Push your hips forwards to increase the stretch.
• Hold for 30 seconds.
• Repeat on the other side.

b) Butterfly Stretch

Instructions:

• Sit on the floor with your back against the wall.
• Brings your feet closer towards you.
• Place the bottom of your feet together.
• Sit as straight as possible.
• Push your knees down.
• Aim to feel stretch in the groin region.
• Hold for 30 seconds.

c) Frog Stretch

Instructions:

• Lie down on your stomach.
• Spread your knee to the side.
• Bring your foot closer to the rest of your body.
• Keep your hips and legs completely relaxed.
• Sink into this position.
• Aim to feel a stretch in the groin region.
• Hold for 30 seconds.
• Repeat on the other side.

d) Cossack Squat

• Start in a standing position.
• Have your feet wide apart.
• Drop down to one side.
• Keep your foot pointing upwards.
• Push your hips forwards.
• Aim to feel a stretch in the groin.
• Hold for 30 seconds.
• Repeat on the other side.

Strengthen External Rotators of Hip

The goal with these exercises is to focus on the most challenging exercise that you can perform with good control and technique.

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a) Hip Rotation (Lying Down)

Instructions:

• Lie down on your back.
• Keep your leg straight throughout this exercise.
• Pivot the leg outwards. (External Rotation)
• Aim to feel a contraction in the muscles of the outer hip.
• Hold for 5 seconds at the end range.
• Repeat 20 times.
• Repeat on the other side.

b) Clam Shell

Instructions:

• Lie on your side with your hip and knees slightly bent.
• Whilst keeping your ankles together, lift up your knee (on the upper side) as high as possible.
• Make sure that you do not move your pelvis as you are lifting your knee.
• Aim to feel the muscles on the side of your hip engage.
• Hold for 3-5 seconds at end range.
• Repeat 20 times.
• Repeat on the other side.

c) Sitting with Resistance Band

Instructions:

• Sit upright on a chair with your knees bent to 90 degrees.
• Loop a resistance band around both of your knees. (see above)
• Keep your feet shoulder-width apart.
• Push your knees outwards.
• Aim to feel a muscular contraction on the side of your hip.
• Hold for 30 seconds.
• Repeat 3 times.

d) Bridge

Instructions:

• Lie down on the floor with knees bent.
• Wrap a resistance band between your knees.
• Keep your feet and knees shoulder-width apart.
• Push your knees outwards. Maintain this position throughout the exercise.
• Aim to feel a muscular contraction on the side of your hip.
• Push your hips upwards.
• Hold for 5 seconds at the end range.
• Repeat 20 times.

e) Forward Lunge

Instructions:

• Wrap a resistance band around your knee.
• Tie the other end of the band to a stationary object so that the band is crossing in front of you.
• Make sure the band is pulling towards in the inside of the knee.
• Move your body away from the anchor point to create a firm amount of tension on the resistance band.
• Assume the lunge position.
• Perform reverse lunges without letting the knee collapse inwards.
• Keep the knee pointing forwards.
• Repeat 20 times.
• Repeat on the other side.

f) Crab Walk

Instructions:

• Wrap a resistance band around your legs as shown above.
• Proceed to take small side steps with each leg over a short distance.
• Keep your pelvis level through the exercise.
• Aim to feel a muscular contraction on the side of both hips.
• Continue for 1 minute.

g) Band Squat

Instructions:

• Stand up.
• Wrap a resistance band around your knees.
• Push your knees out throughout this exercise.
• Perform a squat.
• Repeat 20 times.

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B. Tibial Internal Rotation

This is usually a structural issue that can not be changed. However – I would strongly recommend performing the following exercises to see what movement you might be able to reclaim.

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Releases

a) Inner Hamstrings and Popliteus

Instructions

• Sit on the floor.
• Place a massage ball underneath the back and back/inner side of your knee.
• Place your hands on top of your knee.
• Keep your leg completely relaxed.
• Proceed to apply a downward pressure on your knee towards the ball.
• Continue for 1 minute.

Joint Mobilization

b) Tibial External Rotation

Instructions:

• Sit on the edge of a chair.
• Start with the knee in 90 degrees of flexion.
• Whilst keeping your knee pointing forwards, position your foot to point towards the outside.
• Using both of your hands, firmly grasp the area underneath the knee.
• Keep your knee relaxed.
• Proceed to twist your hands towards the outside of the leg.
  • (Tibial External Rotation)
• Perform 30 repetitions.
• Progression: Gradually perform this technique with your leg in a more straightened position.

Strengthening

c) Tibial External Rotation

Instructions:

• Sit down on the edge of a chair.
• Hold your knee with your hands to keep it pointing forwards throughout this exercise.
• Pivot your tibia towards the outside.
• Perform 30 repetitions.
• Progression: Perform this technique with your leg in a slightly more straightened position.

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C. High Arches in Feet

If your intoeing is due to the high arches in the feet, you will need to focus on the following exercises.

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Releases

a) Muscles in the Arch

Instructions:

• Place your foot on top of a massage ball.
• Apply a firm amount of pressure on top of the ball.
• Roll your foot forwards/backwards.
• Aim to cover the entire arch of the foot.
• Continue for 2 minutes.

b) Tibialis Posterior

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Using your thumbs, press into the area as shown in the above image.
• Continue for 1 minute.

Stretches

a) Plantarfascia

Instructions:

• Kneel down on the floor.
  • (You can place a pillow underneath your knees for comfort.)
• Make sure that the toes are bent backwards.
• Shift your body weight on top of your toes and forefoot.
• Aim to feel a stretch underneath the foot.
• Hold for 30 seconds.

(Note: Please be careful with the kneeling position if you have knee issues.)

Joint Mobilization

The following exercises will help loosen up the tight joints that may be locking the foot into the high-arched position.

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a) Forefoot

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Hold the midfoot with one hand.
• Using your other hand, place your thumb under the base of the big toe and the other fingers on top of the base of the pinky toe. (See image)
• Whilst anchoring the midfoot still, push into the base of the big toe to rotate the forefoot away from you.
• Perform 30 repetitions.

b) Midfoot

Instructions:

• Sit down on a chair.
• Place the ankle on top of the other knee.
• Locate the Navicular bone:
  • Feel for a bony prominence at the top of the arch.
• Place both thumbs above this bone.
• Apply a downward pressure in the direction towards the bottom of the foot.
• Perform 30 repetitions.

c) Hindfoot

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Wrap your hand around the heel.
• Firmly grip the ankle with the other hand.
• Whilst keeping the ankle still, push the heel towards the ground.
• Aim to feel a pulling sensation in the inner side of the ankle.
• Perform 30 repetitions.

d) Drop the Arch

Instructions:

• Stand on one foot.
• Hold onto a stationary object for balance.
• Activate the muscles of the arch.
• Shift your weight on the inner side of your foot.
• Allow your arch to drop as much as possible.
• Do not let the knee collapse inwards.
• Perform 30 repetitions.

(Note: If you are not able to stop the knee from moving towards the midline as you collapse the foot, you will need to focus on the other foot exercises until it becomes easier.)

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Check out this blog post for more exercises for High Arches?
Exercises for High Arched Feet

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D. Maintain your alignment

The next step is to practice maintaining the ideal alignment of the hip/knee/foot.

AIM: Do not let your feet and/or knees to rotate inwards.

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a) Wall Push

Instructions:

• Lift your knee up to hip height and place the side of that leg against a wall. (See position above)
• Bend your planted leg slightly.
• Push the lifted leg into the wall.
• Aim to feel a muscular contraction on the side of both hips.
• Hold this position for 10 seconds.
• Repeat 5 times.
• Perform on the other side.

b) Single Leg Balance

Instructions:

• Stand on one leg.
• Make sure to keep your pelvis level throughout this exercise.
• Make sure to keep your foot and knees facing forwards.
• Keep your torso upright.
• Maintain your balance! Try your best not to wobble.
• To challenge your balance:
  • Alternate lifting your arms or,
  • Look behind your left and right shoulder.
• Continue for 1 minute.
• Repeat on the other side.

c) Hinge

Instructions:

• Stand on one leg.
• Keep your pelvis leveled throughout this exercise.
• Make sure to keep your foot and knees facing forwards throughout this exercise.
• Hinge forwards.
• Aim to feel a muscular contraction on the side of the hip of the stance leg.
• Repeat 10 times.
• Perform on the other side.

d) Step Up

Instructions:

• Place your foot onto a step.
• Make sure that the foot and knee are pointing forwards.
• You can hold onto something for balance. (If Required)
• Slowly load the front leg with your body weight whilst maintaining the alignment between the foot and knee.
• Keep the knee pointing forwards.
• Step up.
• Repeat 10 times.
• Repeat on the other side.

e) Step Down

Instructions:

• Stand on top of a step.
• You can hold onto something for balance. (If Required)
• Slowly step down with one leg as you maintaining the alignment of the knee and foot.
• Keep the knee pointing forwards.
• Repeat 10 times.
• Repeat on the other side.

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Avoid these positions

The following positions are to be avoided as they encourage the habitual internal rotation of the hips.

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a) W Sitting

This is a sitting position on the floor where the feet flare out to the side.

(It tends to be more commonly seen in children.)

b) Sitting with Knees Together/Feet Apart

Sitting with the knees together and feet apart places the hip into an internally rotated position.

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Conclusion

Pigeon Toe is a postural issue where the feet point inwards.

The presence of Pigeon Toe does not automatically mean that there will be issues directly associated with it.

However – the in-toed position of the feet alters the ideal alignment of the lower limb which may place more stress on certain structures of the leg.

There are multiple areas of the body (such as the Hip, Knee and Foot) which can potentially lead to this postural issue.

The exact area that is leading to the Pigeon-Toed presentation will need to be address with the specific exercises as suggested on this blog post.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.