The opposite of pigeon-toed is “out-toeing,” sometimes called being duck-footed or splay-footed. While pigeon-toed means the feet point inward during walking, out-toeing means the feet point outward, away from the body’s midline. Both are rotational variations of the lower extremity, and out-toeing is less common than its inward counterpart.
What Out-Toeing Looks Like
When someone is out-toed, their feet angle outward with each step instead of pointing straight ahead. It’s most noticeable during walking or running, where it can create a slight waddling gait. Some people have it in one foot, others in both. The degree varies widely, from a barely noticeable outward angle to a pronounced duck-footed stance.
Where the Rotation Comes From
Out-toeing isn’t always a foot problem. The outward rotation can originate at three different points along the leg: the hip, the shinbone, or the foot itself.
- The hip: A condition called femoral retroversion means the thighbone is twisted outward in its socket. This is common in early infancy, often caused by the baby’s position in the womb. On physical exam, the hip can rotate outward to almost 90 degrees while inward rotation is limited.
- The shinbone: External tibial torsion is when the lower leg bone is rotated outward more than normal. This typically shows up between ages four and seven. Unlike hip-related out-toeing, this form tends to get worse over time because the shinbone naturally rotates outward as a child grows.
- The foot: Flat feet with an outward tilt (called pes planovalgus) can make the foot itself point outward even when the leg bones are aligned normally. In newborns, a related condition called calcaneovalgus foot causes the foot and ankle to bend excessively upward, sometimes with the toes nearly touching the shin.
Out-Toeing in Children vs. Adults
Most out-toeing in children is a normal part of development. When it stems from hip rotation in infants, it typically improves during the first year of walking. If it persists past age three, that’s when imaging and a specialist referral become appropriate.
External tibial torsion is a different story. Because the shinbone continues to rotate outward as a child grows, this type of out-toeing may not resolve on its own and can actually worsen with age. This makes it the form most likely to carry into adulthood.
Adults with persistent out-toeing often have no symptoms at all. But for some, the altered alignment puts extra stress on nearby joints. The body compensates for the foot position by shifting loads through the knees, hips, and lower back, which can lead to chronic pain in those areas over time. Balance and stability during sports or physical activity can also be affected.
When Treatment Is Needed
The vast majority of children with out-toeing never need treatment. Observation is the standard approach, especially in the first few years of life. There’s no evidence that special shoes, braces, or inserts change the natural course of rotational development in young children.
Physical therapy can help in cases where out-toeing causes pain or functional problems. Strengthening the muscles around the hips and improving flexibility may reduce compensatory strain on the knees and back, even if the underlying bone rotation doesn’t change.
Surgery is rare and reserved for significant cases that cause disability. It’s almost never considered before age 10. The procedure, called a derotational osteotomy, involves cutting and realigning the bone to correct the twist. For external tibial torsion specifically, surgery may be recommended to prevent long-term problems like kneecap pain and knee joint instability, but only after conservative options have been exhausted.
How It Compares to Pigeon Toes
Pigeon toes (in-toeing) and duck feet (out-toeing) are mirror images of each other, caused by the same types of rotational variation but in opposite directions. In-toeing is more common in young children and almost always resolves by school age. Out-toeing tends to appear a bit later, is less common overall, and has a slightly different trajectory depending on the cause.
One key difference: the shinbone version of out-toeing can worsen with growth, while the equivalent in-toeing pattern (internal tibial torsion) typically corrects itself. This makes monitoring more important for children whose feet turn outward, particularly if the rotation seems to be increasing rather than improving as they get older.