Slew-footed is a common term describing a physical presentation where one or both feet turn outward instead of pointing straight ahead during walking or standing. Medically known as out-toeing, this external rotation of the lower limb is frequently noticed in young children learning to walk, but it can persist into adolescence and adulthood. While often a harmless variation in development, out-toeing can occasionally signal an underlying structural or muscular issue that warrants attention.
Defining Slew-Footedness (Out-Toeing)
Slew-footedness is characterized by the feet rotating externally, sometimes referred to as being “duck-footed.” This gait pattern is the opposite of in-toeing, or being “pigeon-toed,” where the feet angle inward. The rotation is typically defined when the feet point outward more than 15 degrees from the midline when walking.
This deviation can originate from different points along the lower limb, including the hip, the thigh bone (femur), the shin bone (tibia), or the foot itself. The specific origin of the rotation influences the overall walking pattern. Observing the direction of the kneecaps during walking can indicate whether the rotation begins at the hip or further down the leg.
Common Causes of Outward Foot Rotation
The outward rotation of the foot can stem from a misalignment in the long bones of the leg, known as skeletal torsion. One common source is external tibial torsion, where the shin bone is twisted outward relative to the knee joint. This twist often develops during fetal development or early childhood growth and is the most frequent cause of out-toeing in toddlers.
Another primary skeletal cause is femoral retroversion, which involves an outward twist of the thigh bone (femur). In this case, the hip joint socket is angled slightly backward, causing the entire leg to externally rotate.
Muscular imbalances also contribute, particularly in adults or older children. Tightness in external hip rotator muscles, such as the piriformis, can pull the thigh bone into a rotated position. Conversely, weakness in opposing internal rotator muscles may allow the external muscles to dominate.
Furthermore, a collapsed arch in the foot, known as pes planus or flat feet, may cause the foot to roll inward (pronation). This rolling can visually exaggerate the appearance of out-toeing.
Physical Impact and Associated Symptoms
The altered mechanics of a slew-footed gait lead to uneven distribution of forces throughout the lower body. This incorrect force transmission places increased stress on the joints, particularly the knees and hips, which can cause discomfort over time. Compensation for the outward rotation may result in a noticeable waddling gait, especially when running.
Specific symptoms include patellofemoral pain (runner’s knee) due to the misalignment of the kneecap tracking. Individuals may also experience increased foot fatigue or shin splints as muscles work harder to stabilize the externally rotated limb. Uneven wear on shoes, showing excessive degradation on the outer edge of the heel and sole, is a clear sign of altered biomechanics.
Assessment and General Management
A professional assessment is warranted if the out-toeing is unilateral, causes pain, leads to frequent tripping, or worsens over time. A medical provider will perform a physical exam, including measuring the angles of rotation in the hip and shin to determine the precise anatomical source. For children, a large percentage of mild cases resolve naturally as the child grows, often by the age of eight.
For persistent or symptomatic cases, management focuses on improving alignment and muscular balance. Physical therapy is often recommended to strengthen internal hip rotators, such as the gluteus medius, and to stretch tight external rotators. Supportive footwear and orthotics can be beneficial, particularly when flat feet are a contributing factor. Orthotics provide arch support and heel stabilization, which helps improve foot positioning.