We are used to hearing reports of chiropractic care being useful for the correction of postural abnormalities. That happy side-effect of subluxation-based care is so common that it’s almost to be expected. Pigeon toes, though – now that’s so rare that it hasn’t been spotted yet in chiropractic literature. In fact, traditional treatment is usually limited to braces or other apparatus designed to correct the problem, and effectiveness is usually best indicated by patient compliance.
That’s what makes a new case report so interesting. It’s a new entry into the chiropractic literature bank. Can chiropractic care assist with in-toeing (the technical name for pigeon-toe)? One case report says yes, and that certainly piques our curiosity.
Pigeon toe, or in-toeing, is a condition that manifests as feet and toes pointing in toward each other, commonly seen in children. This condition typically resolves with age as the child continues to grow and develop. However, when the child is walking and sitting with their feet excessively turned inward, it is likely their mobility will be impaired, with them tripping and falling more often.
It’s not a condition limited to the feet, either. This unusual way of holding the hips, legs, and feet can also add strain to joints and areas of the body, increasing uncomfortability and neutral positioning. Affected running and walking can impact a child’s confidence and can cause concern for parents. Conservative approaches to the management of this condition may provide parents and children with an alternative option to gently and proactively support the child’s development, as opposed to watching and waiting for the condition to resolve itself with time.
But as mentioned, usually these conservative measures are braces, orthotics or corrective apparatus that need to be worn. So what makes this case, published in the Asia Pacific Chiropractic Journal, different?
A 2.5-year-old female was presented for correction of in-toeing while walking. The mother noted that she would often trip over her feet and fall, which she suspected to be a result of her child’s foot position.
Aside from this, the young patient was very healthy, receiving a diet of primarily organic and plant-based food. There was no history of serious illness or surgeries, and she was not taking any medications or had experienced any traumatic events in her life. The initial consultation was brief due to the patient’s young age and low compliance level with initial chiropractic care. When checking the iliotibial band on both sides (this is a strong band of tissue running down both thighs), the chiropractor noted hypermobility on turning (passive pronation). Visual examination showed hyperpronation with toe abduction on both sides when she stood and when she walked. Palpation of the iliotibial bands demonstrated some sensitivity. Pre- and post-intervention assessment measurements consisted primarily of visualisation and palpation, as well as reports from the mother on her observations.
The chiropractor employed a gentle, low-force intervention so as to be age-appropriate. (It is quite common for chiropractors to be trained in altering their techniques for lower, age-appropriate force levels when caring for children and babies. This is to accommodate for lower tensile strengths and the different stages of physical and neurological development in our smallest practice members.) Trigger point therapy was also applied to the iliotibial bands to relieve the tension in the area. As care continued, the chiropractor noticed the patient was sitting with her feet at a straighter angle, and care was better received as the patient became more comfortable.
By the third and fourth visits, the patient had formed enough trust for the chiropractor to administer some cervical manipulation and, eventually, cranial manipulation.
With children that are not compliant with positioning, such as with this child in the first couple sessions, it is difficult to determine the effectiveness of any intervention. However, with this little practice member, the chiropractor and the mother were able to see improvements relatively quickly with her pigeon-toed presentation correcting significantly.
What changed?
By the fourth visit, the patient was walking with both feet, mostly straight forward, which continued to improve throughout care. The mother noted that her coordination had improved during care, with an improved ability to steady herself the few times she would still trip, the frequency of which had also reduced. The mother also noted that the child was beginning to sit back more on her buttocks and had less of a forward lean, suggesting tension had reduced in her hips and upper thighs.
This condition is still poorly understood. There are several hypotheses as to why it occurs, with constricted uterine position being one of them, but more research is needed. We also don’t know the full reach of its effects on children with the condition – beyond socioemotional and basic biomechanics. What we do know is we haven’t seen a chiropractic case report on it yet – until now – and anything we can do to support the optimal development of children as they learn to move in, interact with, and perceive the world is a good thing. Let’s see what the future holds.
Reference:
- Stowell LM, Blum CL. Correction of Pigeon Toe or In-Toeing in a 2½ y female with Chiropractic treatments: A case report. Asia-Pac Chiropr J. 2023;4.1
