Pigeoned Toed

Question:

I have a 26 year old female client who is slightly pigeoned toed, mainly on the left foot. Directly above her ankle is a concave area where there appears to be little muscle. The tibialis muscle appears to disappear or dissipate on the outside or her leg above her ankle. As a result, she experiences extreme discomfort walking on the treadmill. At times, her leg tingles and feels devoid of feeling. It is improving as her strength improves, but I am a little baffled with the concave muscle area.

Answer:

To properly address this question, it would be helpful to know a complete medical history of your client. From the initial sounds of it, this might be an issue related to cerebral palsy, which is a neurological disorder related to the development of the brain. A person might have a very mild case of CP that affects either motor or physical development or both. The left foot in a position of "pigeon toed" (supinated: plantar flexed, inverted and adducted) and the "tingling" sensation when walking are indicators of a physical or structural abnormality and a nervous system (motor) irregularity, respectively.

Since diagnosing a structural or neural issue is outside of a fitness professional's scope of practice, it will become necessary for the client to seek medical advice to identify whether or not this is an issue related to cerebral palsy. In order to have a proper diagnosis, it will be necessary for the client to see her primary care physician or receive a referral to a neurologist who can make a complete medical diagnosis that will either identify the cerebral palsy or rule it out as a causative issue.

A physical therapist can help improve range of motion to the left ankle to help the client prepare for the rigors of a regular exercise program. Once the client is cleared from physical therapy, it would help to teach her how to properly warm up her calves to prepare for exercise or a brisk walk around the block.

The training program should focus on a warm up that mobilizes the entire body, especially the feet, in all three planes. A good strategy to stretch and prepare the calf muscles for three-dimensional motion would be to have the client lean against a wall or solid structure with the hands just above shoulder level, place the left foot in a slightly dorsiflexed position (on a small towel or a 2.5 pound plate, nothing more than half or three quarters of an inch), maintain a straight left leg with the hip in full extension and the knee just slightly flexed, then use the right leg to create tri-plane motion in the left calf:

• Lift the right leg and push the knee forward to create motion in the sagittal plane.
• Toe touch with the right foot to the right and left to create motion in the frontal plane.
• Lift the right leg and rotate it side-to-side to create motion in the transverse plane.
• Repeat on both sides.

This three-dimensional mobilization of the calf should improve the ability of the foot to load and absorb force when it hits the ground at heel strike and then unload to create a propulsive force during toe off. Conducting a search for dynamic flexibility exercises for the leg in the PTN Exercise Library should provide some ideas for how to stretch the leg muscles in all three planes.