作者：Pam Versfeld 硕士（物理治疗）。更新于 2024 年 5 月
导致孩子内八字走路的原因是什么，锻炼能否帮助改善这一情况？
鸽子脚，也称为内八字步态，通常是由股骨前倾和胫骨扭转的组合引起的。这些骨骼生长的差异共同导致了腿部的非典型扭转对齐。
在本文中，我描述了髋关节和膝关节如何导致内八字步态，以及力量、柔韧性和协调性训练如何改善走路和站立时脚向内转的倾向。
良好的大腿和小腿对齐
一个腿部对齐良好的孩子站立时，膝盖朝前，双脚平行或稍微向外转。大腿与小腿之间有一个轻微的角度。
双膝和双脚内扣站立
一个孩子可能会双膝和双脚向内站立。
如果是这种情况，那么问题可能是由以下原因造成的：
髋部肌肉的紧绷和虚弱限制了髋关节的外旋（向外扭转）；
股骨正常小量扭转（扭曲）的增加 - 称为股骨前倾。（见下文。）
双膝向前站立，双脚内八字
如果孩子站立时膝盖朝前但脚向内转，问题出在膝盖的旋转运动上，这也可能与胫骨的异常扭转（胫骨扭转）有关。
双膝向前站立，双脚外展
还有相当多的孩子站立时双脚向外。这种向外的扭转被称为外侧胫骨扭转。在许多孩子中，向外的扭转与膝关节过度向外旋转有关，同时内旋受限。
走路时脚尖着地的儿童通常伴有外侧胫骨扭转，且髂胫束紧绷。阅读更多：特发性脚尖行走。
双膝内扣，双脚平行站立
其他孩子的膝盖内扣，但脚朝前。如果是这种情况，孩子就有股骨内旋和胫骨外旋的组合。
胫骨扭转的程度在孩子被指示双膝正对前方站立时最为明显。如果存在胫骨扭转，双脚将向外摆放。
W 型坐姿会导致胫骨外旋
侧胫骨扭转在习惯性地坐在腿间（W 字坐）的儿童中被夸大。在这种姿势下，膝关节被迫进入极度的外旋。
内八字步态是什么？
当一个孩子走路时双脚向内转时，称其为内八字步态。
一个腿部对齐良好的孩子的足迹，与前进线的角度偏离几度。一个内八字步态的孩子的足迹则是朝向前进线的角度。
In-toeing gait is associated with anteversion of the hips as well as hip muscle weakness and tightness.
Hip movements in children who are pigeon-toed
In a typically developing child, aged of 5-6 years, the rotation (twisting) movement at the hip joint allows 45 degrees in both directions. This movement is tested with the child lying on the tummy, with the hips fully extended, the thighs parallel and the knee flexed to 90 degrees.
The lower leg is moved to the left and the right. Typically, by the age of 7-8 years children have about 45 degrees of both lateral and medial rotation. (Sutherland 1988).
Children with in-toeing (pigeon toes) typically have increased internal (inward) rotation of the hip, often as much as 70-80 degrees, and very limited external rotation (usually only 10-20 degrees.)
What is femoral anteversion?
When a typical femur (thigh bone) is placed on a table, the lower end of the femur lies flat on the surface, and the head and neck of the femur are angled forwards slightly. This slight twist in the femur, technically known as femoral torsion, means that when standing erect with the hips in extension the knees face straight forwards.
In some children the amount torsion in the femur in increased, so that the angle between a line through the head and neck of the femur and a line through the lower end of the femur increases from a typical 8-10 degrees to 30-40 degrees.
This twist in the femur means that when the head of the femur fits neatly into the hip socket (acetabulum), the knees are turned inwards.
Infant femurs are naturally anteverted
At birth the angle between the head and neck and the lower end of the femur is large (30-40 degrees). In other words infants are born with femoral anteversion. This degree of anteversion is linked to the flexed position of the infant in the womb. In fact, a full term infant's hips cannot be fully extended.
As the infant grows and develops better hip extension, and then starts to walk and becomes more active, the anteversion angle decreases, until it reaches the mature values of 8-10 degrees in adults.
This normal deroration of the femur depends on strong and balanced action of the hip muscles, in lying, standing and walking.
Link between femoral anteversion and increased hip medial rotation
In most instances, a child who has a large angle of femoral anteversion, will also have increased hip internal rotation, with decreased external rotation.
However, recent research, using MRI scans to confirm femoral anteversion, have shown that the association between the angle of anteversion and the range of hip internal rotation is variable. This means that a child with a very large range of hip internal rotation may not have excessive femoral anteversion.
Femoral anteversion can only reliably be diagnosed with an MRI or CT scan. A diagnosis cannot be made solely on the basis of increased hip internal rotation or an in-toeing gait.
How in-toeing affects standing on one leg
By the age of 5-6 typically developing children can stand on one leg with the the trunk upright and balanced over the standing leg. The knees and feet face forwards, and the child uses small movements of the foot to maintain balance.
Children with limited range of hip external rotation, along with some tightness in the iliotibial band and weakness of the buttock muscles have difficulty standing on one leg with good alignment.
The pelvis and trunk tilt sideways and the knees tend to turn inwards. The child uses hip and trunk movements to maintain balance, rather than the more effective small ankle movements.
In-toeing and the swing phase of gait
Children who walk with the feet twisted inwards usually have difficulties with controlling the position of the foot as the leg is moved forwards to take the next step. The thigh and the foot are turned inwards as the leg is moved forwards and placed down on the floor.
This inwards twist of the leg is associated with weakness of the hip muscles that flex and rotate the hip joint.
Try the following
The difficulties a child experiences with controlling the rotation of the hip in walking, can be seen when a child is asked to lie on the back, lift one leg to 450 and hold the position for 20 seconds. If the child has good strength in the hip flexor muscles the knee will face upwards and the position can be easily maintained for the full 20 seconds.
If the hip flexor muscles are weak child tends to twist the leg inwards so that the knee faces inwards as the muscles get tired.
Does in-toeing improve over time?
Orthopedic surgeons tend to recommend a wait-and-see approach for young children presenting with in-toeing gait The expectation is that the degree of in-toeing will decrease over time and have corrected itself by the age of 8-10 years.
And indeed research has shown that the degree of in-toeing when walking does often improve over time. However the tendency for the thighs to be twisted inwards with the knees turned towards each other when standing and walking may still be present, even when the feet are not turned inwards when standing and walking.
This is because the child compensates for the inwards twist of the thigh by twisting the lower leg outwards at the knee joint.
When in-toeing is associated with femoral anteversion
If the in-toeing is severe and interferes with function, and there is marked anteversion of the femur, the child's orthopedic surgeon may recommend a derotation osteotomy to correct the twist in the femur.
An MRI or CT scan is needed to establish a diagnosis of anteversion of the femur. It is important to note that while in most cases and increased anterversion angle is usually associated with excessive internal rotation of the hip, this may not always be the case. (Kim et al 2011)
The opposite is also true, a large angle of hip internal rotation does not necessarily mean that femoral anteversion is present.
In severe cases of femoral anteversion, most often seen in children with cerebral palsy a derotation osteotomy improves the biomechanics of the hip joint and allows the muscles to start working more effectively when walking.
Can exercises improve in-toeing?
An exercise program to improve the weakness and tightness of the hip muscles can improve not only the degree of in-toeing in standing and walking, but also improve the child's ability to perform gross motor tasks that involve walking, running, balance and jumping.
An exercise program is particularly helpful when the degree of anteversion is not severe, and may even help to accelerate the normal reduction in the angle of anteversion which occurs over time.
It must be kept in mind that an exercise program while improving strength, flexibility and function will probably not affect severe femoral anteversion to any degree. However, if a de-roration osteotomy is being considered, improving a child's strength, flexibility and function before surgery will improve the outcome.
A program of exercises to improve pigeon toes (in-toeing) when standing and walking
The SfA exercise program includes exercises designed to improve the impaired flexibility, muscle strength and coordination commonly experienced by children who stand and walk with in-toeing.
Children will only participate in an exercise program if it is interesting, there is a bit of a challenge and they experience success. All exercises start with an easy version and provide instructions for increasing the difficulty.
Hip muscle stretching exercises to improve the ability to extend and laterally rotate the hip joint
Standing on one leg exercises: to improve the ability to stand on one with good pelvic and leg alignment.
Hip flexion exercises: to improve the child's ability to lift the leg forwards with the foot straight.
Walking exercises: to improve foot placement, balance and coordination.
Subscribe to the SfA Training Guide for access to these exercise instructions
Includes PDF files for home exercise programs (HEPs).
Disclaimer: The content on this site is provided for general information purposes only and does not constitute professional advice.
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