The common observation of a person’s feet pointing away from the body during walking is colloquially known as “duck feet.” This outward presentation is a rotational variation that frequently occurs during childhood development. The medical community uses a precise term to describe this gait pattern, which typically arises from one of three anatomical areas: the hip, the shin bone, or the foot itself.
The Technical Term: Out-Toeing
The medical term for feet pointing outward during walking is Out-Toeing, sometimes called a “Toe-Out Gait.” This rotational deformity is the opposite of in-toeing (“pigeon toes”). The foot progression angle is externally rotated, meaning the feet point away from the body’s midline instead of straight ahead.
A specialist diagnoses out-toeing by measuring the angle of gait, which is the angle formed by the long axis of the foot and the line of forward progression during a stride. A positive angle indicates the foot is pointing outward, while a negative angle indicates in-toeing. This external rotation can originate from anywhere along the leg, from the thigh bone down to the foot.
Identifying the Anatomical Source of Rotation
The source of the outward rotation is located in one of three primary areas of the leg. Determining the location is crucial for understanding the likely outcome and management. These variations often relate to the baby’s position inside the womb before birth. The three main anatomical causes are femoral retroversion, external tibial torsion, and compensatory mechanisms at the foot or ankle.
Femoral Retroversion (Hip)
Femoral retroversion occurs when the thigh bone, or femur, is twisted or angled backward relative to the hip joint. This anatomical twist causes the entire lower extremity, including the knee and foot, to rotate externally. The condition is often present at birth due to the natural, externally rotated posture of the baby’s hips in the uterus.
This hip-level rotation is a common cause of out-toeing in infants and young children. It frequently resolves spontaneously as the child grows and begins walking, typically correcting itself by 12 months old. For those who do not outgrow it, it can be associated with an increased risk of hip conditions later in life, such as a slipped capital femoral epiphysis (SCFE).
External Tibial Torsion (Shin Bone)
External tibial torsion is an outward twisting of the shin bone (tibia), the long bone between the knee and the ankle. This twisting causes the lower leg and foot to point outward, even if the hip alignment is normal. This cause of out-toeing is often noticed later in childhood, commonly between four and seven years of age, and is less likely to correct spontaneously compared to hip contracture.
Unlike femoral retroversion, external tibial torsion tends to worsen as the child grows because the tibia naturally rotates externally with physical development. When one leg is affected more than the other, which is common, it may increase the risk of knee issues, such as patellofemoral pain, due to the misaligned forces acting on the joint.
Compensatory Mechanisms (Foot/Ankle)
Sometimes, out-toeing is not caused by a twist in the long bones but is a compensatory mechanism originating in the foot or ankle. The most frequent example is flexible flat feet (pes planus). When the foot lacks a proper arch, it rolls inward to seek stability, resulting in the forefoot pointing outward to maintain balance during walking.
Tightness in muscle groups, such as the hip rotators or calf muscles, can also influence gait and contribute to external rotation of the foot. The body attempts to find the most comfortable and stable way to move, which can result in the foot splaying outward. This type of out-toeing is a response to another biomechanical issue.
Non-Surgical Management and Monitoring
For the majority of children, especially toddlers, the primary approach to managing out-toeing is watchful waiting. Since many cases are a result of intrauterine positioning and resolve naturally by age six to eight, observation is the most common recommendation. Parents are often encouraged to periodically record videos of the child walking to monitor the natural rate of correction over time.
Physical therapy can be beneficial in cases where muscle imbalance or tightness is a contributing factor. Exercises focus on strengthening the internal hip rotators and improving core stability to encourage a more forward-aligned gait. Gentle stretching routines for tight muscles, such as the hip flexors and adductors, may also be incorporated to reduce the external pull on the leg.
For compensatory out-toeing related to flat feet, conservative measures like custom-made orthotic insoles or supportive footwear may be recommended. Orthotics provide stability to the foot’s arch, helping to control the excessive inward roll and reducing the need for the foot to splay outward. However, special shoes or braces have largely been proven ineffective at correcting the bone alignment itself.
When to Consult a Specialist
While out-toeing is often a normal developmental phase, certain signs indicate the need for a consultation with a specialist, such as a pediatric orthopedic surgeon or podiatrist. The presence of pain in the hip, knee, or leg warrants immediate evaluation. If the child develops a noticeable limp or experiences difficulty with mobility, running, or keeping up with peers, a professional assessment is appropriate.
Asymmetry is another red flag, such as when one foot turns out significantly more than the other. This unilateral presentation can sometimes signal a more serious, although rare, underlying condition like a slipped capital femoral epiphysis (SCFE). If the out-toeing does not improve or appears to worsen after age eight to ten, a specialist should be consulted to rule out persistent structural issues. Surgical correction (osteotomy) is considered only in rare, severe cases that cause significant functional impairment or pain and have failed conservative management.