The common term for feet turning outwards is “out-toeing,” also known as “duck-footed.” This condition describes a foot progression angle where the feet point away from the body’s midline during movement. It is considered the opposite of “in-toeing,” where the feet point inward. Out-toeing can be observed in one or both legs.
Individuals with out-toeing may exhibit a waddling gait, and their knees might also appear to point outward. While typically not associated with pain, this alignment can sometimes cause an awkward walking style or uneven wear on shoe soles.
Common Reasons for Feet Turning Out
Several factors can contribute to out-toeing, often stemming from the development and alignment of bones in the legs and hips. One common cause is external tibial torsion, which involves an outward twisting of the shin bone (tibia). This twisting can cause the entire lower leg and foot to point outward. This condition typically becomes apparent in late childhood or early adolescence, sometimes affecting only one leg.
Another contributing factor is femoral retroversion, where the thigh bone (femur) is externally rotated relative to the hip joint. This can result in both the knees and feet turning outward. This rotational variation can also be linked to the position of a baby in the womb, which may lead to an externally rotated posture of the lower limb after birth.
Muscle imbalances or tightness in the hip muscles can also play a role, as these can cause the hip to rotate excessively outward. Additionally, flat feet, or pes planus, where the foot’s arch collapses, can contribute to the appearance of out-toeing by causing the feet to splay outwards. In some instances, out-toeing may also be associated with conditions like slipped capital femoral epiphysis (SCFE), a hip condition where the top of the thigh bone slips.
When to Consult a Professional
Out-toeing is often a temporary part of development, particularly in toddlers learning to walk, and frequently resolves without intervention by ages six to eight. In many cases, it does not cause pain or interfere with a child’s ability to walk or run. However, there are specific signs that suggest a consultation with a healthcare professional may be beneficial.
Parents should seek medical advice if the out-toeing persists beyond the typical resolution age, generally after eight years old. A doctor’s visit is also warranted if the condition is accompanied by pain in the legs, hips, or groin, or if the child frequently limps or falls. Asymmetry, where one foot turns out significantly more than the other, or if the condition worsens over time, are also reasons for evaluation. For adults, if out-toeing causes discomfort, limits mobility, or is associated with pain, seeking an expert opinion is advisable.
General Management Approaches
For many cases of out-toeing, particularly in young children, observation is the primary approach, as the condition often improves naturally as the child grows. This watchful waiting is common because the bones involved, such as the shin and thigh bones, naturally untwist during the early years of life.
If the out-toeing persists or causes functional difficulties, conservative measures may be recommended. Physical therapy can help improve gait mechanics by strengthening lower extremity muscles and enhancing flexibility. Specific exercises might be prescribed to address muscle tightness or weakness contributing to the outward rotation. Orthotics, such as custom shoe inserts, may also be used to support foot alignment, especially if flat feet are a contributing factor.
Surgical intervention for out-toeing is rare and typically considered only in severe cases that do not respond to conservative management or when there is significant functional impairment, pain, or risk of long-term joint problems. Procedures like derotational osteotomy involve cutting and realigning the bone to correct severe twisting of the shin or thigh bone. This option is generally reserved for older children or adolescents after other approaches have been exhausted.