Massage therapy · Kitchener–WaterlooInternal Tibial Torsion
Ankle & Lower Leg
What It Is
Internal tibial torsion is an inward twist of the shin bone (the tibia), the bone between the knee and the ankle (West Suffolk NHS Foundation Trust, 2021). The twist makes a child's feet turn inward, giving a "pigeon-toed" appearance (AAOS, n.d.). It is very common in infancy and childhood (West Suffolk NHS Foundation Trust, 2021), and it is usually first noticed when a toddler starts walking (AAOS, n.d.).
When children are first learning to walk, tibial torsion makes the feet point inward (in-toeing). Children with in-toeing may be prone to tripping, or may look a little awkward when walking or running (West Suffolk NHS Foundation Trust, 2021).
Tibial torsion is thought to be related to the position of the baby in the womb, as the legs rotate to fit into the limited space (AAOS, n.d.). It also tends to run in families (AAOS, n.d.).
Internal Tibial Torsion Anatomy
Not a diagnosis — for more information, contact me or another trusted healthcare provider.
Treatment
Self-Care & Treatment
How to Treat an Internal Tibial Torsion
Tips
- In most children, tibial torsion is related to the normal position of the baby in the limited space of the womb (AAOS, n.d.).
- Some degree of in-toeing is normal in childhood (West Suffolk NHS Foundation Trust, 2021).
- The condition usually corrects itself as the child grows (AAOS, n.d.).
- Because tibial torsion is a developmental difference that can run in families, it usually cannot be prevented (AAOS, n.d.).
Treatment
My Approach
Internal tibial torsion almost always corrects itself as your child grows, and massage can't change the twist in the bone. Your child's doctor leads their care. I support it by keeping an eye on how your child moves, and by helping with recovery in the rare case that surgery is needed.
I watch how your child stands, walks and plays, and check how their hips, knees and feet move. If only one leg is affected, the in-toeing is severe or getting worse, or your child has pain, swelling or a limp, I'll ask you to see your child's doctor. Parents are welcome to sit in, with your child's agreement.
Day to Day
- Encouraging normal play; no special exercises are needed for the twist itself
- Care for parents and caregivers, whose neck, shoulders and back can take the strain of carrying a young child, especially one in a cast
After Surgery
What to Expect
Typical Course
What I Focus On
Please read
When to See a Doctor First
When to see your child's doctor
- The in-toeing affects only one leg (West Suffolk NHS Foundation Trust, 2021).
- The in-toeing is severe and not improving with time (West Suffolk NHS Foundation Trust, 2021).
- The in-toeing is causing tripping in a school-age child that affects their activities (West Suffolk NHS Foundation Trust, 2021).
- Your child has pain, swelling or a limp (AAOS, n.d.).
Sources
References
- American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Intoeing. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/intoeing/ (Accessed: 7 October 2026).
- West Suffolk NHS Foundation Trust (2021) Intoeing in children. Available at: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/TraumaandOrthopaedics/6083-1-Intoeing-in-children.pdf (Accessed: 7 October 2026).