What to Know About Out-Toeing

Out-toeing is a type of torsional deformity. It typically occurs when one of the leg’s two longest bones turn toward the outside of the leg, causing the foot to jut out:

Duck-Footed: Out-Toeing, or the Opposite of Pigeon-Toed

Some toddlers walk with a duck-footed gait as they learn to use their new-found ability to walk — it’s also known as out-toeing. This means that they waddle-walk with their toes pointed outward rather than forward.

Out-toeing can also sometimes manifest for the first time in adolescents, teens, or adults. It’s not always a cause of concern, but it’s worth knowing the difference between a natural duck-footed gait and a condition that impacts how you walk.

Read on to learn the causes of this condition, when you should seek medical help, and information about solutions.

Out-toeing is a type of torsional deformity. It typically occurs when one of the leg’s two longest bones turn toward the outside of the leg, causing the foot to jut out:

• tibia: located between the knee and ankle
• femur: located between the hip and knee

Out-toeing can occur in one or both legs. In many young children, out-toeing is typically temporary and short-lived. But duck-footedness can persist into adolescence or beyond, sometimes well into adulthood.

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Having flat feet can also cause the appearance of out-toeing.

Is it similar to being pigeon-toed?

You may be familiar with a more common torsional deformity called in-toeing — being pigeon-toed. It’s essentially the opposite of being duck-footed.

With a pigeon-toed gait, you walk with your toes pointed in an inward direction rather than outward.

Out-toeing can make a child look like they’re waddling from side to side. You may notice that your child’s knees also appear to point outward.

Out-toeing is not typically associated with pain or discomfort. It also doesn’t usually interfere with a child’s ability to walk, run, or be mobile in any way.

Out-toeing may be more obvious when a child runs than when they walk. Parents may also notice that their child’s shoes wear out or have more noticeable scuff marks on the outer edges of the shoes.

You can check for out-toeing in adults by standing naturally with your feet about 1 foot apart. Look down at the position of your toes — if they point outward instead of straight ahead, you are probably duck-footed.

Here’s another way to see if you’re duck-footed:

1. Lie down on your back.
2. Do your feet turn outward along with your knees? You may have out-toeing caused by tight hip muscles.

There are several common causes of out-toeing in toddlers or children, including:

• family history of being duck-footed
• fetal position of the legs in the uterus prior to birth
• resting position of the legs during infancy
• being flat-footed

Some rare causes of out-toeing include:

• congenital bone deformity
• slipped capital femoral epiphysis, a hip condition that causes the ball at the top of the femur to slip backwards.

Slipped capital femoral epiphysis

Capital femoral epiphysis occurs in adolescents or teens who are still growing. It is sometimes referred to as a disorder of the hip growth plate.

In adults, out-toeing may be the result of:

• injury to the leg, hip, ankle, or foot
• muscle tightness in the legs or hips
• poor posture
• a sedentary lifestyle that results in an anterior pelvic tilt or a pelvis that tips forward

Anterior pelvic tilt in adults

An anterior pelvic tilt causes the hip muscles to tighten, which rotates the femur outward and can result in duck-footedness.

In adults, out-toeing may be mild or extreme. If your condition doesn’t stop you from participating in activities such as walking, running, or swimming, it is not cause for alarm.

If you are concerned about your child’s gait at any point during their development, talk to their doctor.

Children typically outgrow duck-footedness between the ages of 6 and 8. Here are some tips for when you should see a doctor if your child’s condition persists beyond that time or if you’re experiencing symptoms:

• Your child limps or falls often while walking or running.
• Your child has ongoing or intermittent pain in the legs, hips, or groin — this may indicate slipped capital femoral epiphysis. Pain can be mild or severe, and may be ongoing or come on suddenly.
• Your child has a sudden inability to walk (this may also indicate slipped capital femoral epiphysis).
• Your condition is severe and causes pain, imbalance, or instability.

Mild out-toeing can often be resolved with at-home treatment. Here are some remedies you can try at home.

Retrain your stance

Become more conscious of the way you position your feet when you walk or stand. This can help alleviate or reduce out-toeing.

Use orthotic inserts

Look for orthotic inserts that support and lift the arch of the foot. These may help stabilize the heel and improve alignment.

Stretching and exercising

Exercises that stretch the hamstrings and hips can have benefit for mild out-toeing. Here are some easy stretches you can try at home.

Wall stretch

1. Place a foot stand or several thick books around 2 feet away from a wall.
2. Stand on the foot stand, but allow your heels to drop down off the back edge.
3. You’re in the correct position if your arches are supported but your heels aren’t.
4. Lean toward the wall and let your hands support your body. Your hands should be against the wall at shoulder length and your arms should be fully extended.
5. Lift your feet up and down, one at a time, stretching the foot and calf.

Tennis ball roll

1. Sit on the floor with your legs outstretched in front of you.
2. Place a tennis ball under your calf, and roll it back and forth for about 2 minutes.
3. Increase the stretch by flexing your foot while you continue to roll the ball.
4. Try rolling the ball on the outside of your leg if it feels tight, tender, or sore.
5. Repeat on the other leg.
6. Repeat several times a day.

Piriformis stretch

1. Lie down on your back and bend your knees so that your feet are on the floor about hip width apart.
2. Cross one leg over the other with your ankle pressing into your thigh just above the knee.
3. Gently push down with your ankle and hold for 60 seconds.
4. You should feel a slight stretch throughout the thigh, hip, and lower back.
5. Repeat on the other side.

Any feeling of pain, discomfort, or a lack of mobility should prompt a call to the doctor for both children and adults. You should also contact your child’s doctor if they fall or limp often.

You may also consider seeing a doctor or physical therapist before trying to treat mild out-toeing at home.

A medical professional can determine if your condition is caused by muscle tightness or an outwardly turned tibia or femur. This can help determine what exercises may be most effective.

Here are some of the methods and tests your doctor may use to determine whether you or your child is duck-footed:

• Intake: may determine how long the condition has persisted and if there are any incidents that may be the cause. They will also ask about family history.
• Physical examination: centers on the legs, hips, and feet. Your doctor will be looking for signs of tightness, lack of flexibility, and range of motion.
• Degree of rotation: determined in the leg bones by assessing the angles between the feet and legs. This is typically done by having you lie down on your stomach with knees bent for visual analysis.
• Footwear: your doctor may also examine your footwear and have you walk around in your common footwear to see your typical gait.
• Running: your doctor may have you run to see if you waddle from side to side as well as examine the position of the feet while in motion.
• Imaging tests: your doctor may order X-rays or an MRI if they suspect a serious condition like slipped capital femoral epiphysis.

Here are some possible medical treatments for duck-footedness that your doctor may recommend:

• Watchful waiting: if your child is under 6 years old, their doctor may recommend watching and waiting to see if the condition resolves on its own.
• Physical therapy: a physical therapist can help oversee exercises that may retrain the legs and feet or reduce pressure and tightness in the hips.
• Surgery: if a bone deformity or slipped capital femoral epiphysis is found, surgery may be recommended.

When severe out-toeing is left unchecked, it may eventually cause other conditions, such as:

• muscle atrophy in the lower legs and glutes
• knee injury
• ankle injury
• flat feet
• foot pain
• damage to the piriformis muscle, which can result in sciatica

Out-toeing, or being duck-footed, is a condition marked by feet that point outward instead of straight ahead.

It’s most common in toddlers and young children, who typically outgrow it by age 8. Adults can also become duck-footed as the result of a sedentary lifestyle, poor posture, injury, or other causes.

This condition is rarely serious and typically responds well to treatments at home. Contact your child’s pediatrician if you have any concerns about your child’s gait.

Last medically reviewed on December 14, 2020

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Accadbled F, et al. (2006). In-toeing and out-toeing.
  pubmed.ncbi.nlm.nih.gov/16584043/
• Schoenleber S. (2020). What is out-toeing?
  nicklauschildrens.org/conditions/out-toeing
• Slipped capital femoral epiphysis. (n.d.).
  orthoinfo.aaos.org/en/diseases–conditions/slipped-capital-femoral-epiphysis-scfe
• Torsional deformity. (2019).
  health.harvard.edu/a_to_z/torsional-deformity-a-to-z

What to Know About Out-Toeing

People who are “out-toed” have toes that point out to the side instead of straight ahead. This condition is the opposite of pigeon-toed, also called in-toeing. If your child is pigeon-toed, their feet point inwards.

Causes of Out-Toeing

Some cases of out-toeing are caused by your baby’s position in your uterus before they were born.

In some cases, it is caused by tibial torsion. If your baby’s hips were pressed with the tibia rotating outwards in the uterus, they may have out-toeing as a toddler. If their hips were pressed with the tibia rotating inwards, they may be pigeon-toed as a toddler.

Other less common causes of out-toeing include:

• Flat feet. This is the lack of an arch in the foot. Sometimes this can lead to out-toeing in children.
• Cerebral palsy. Some people with CP have out-toeing in one or both legs due to muscle imbalances.
• Legg-Calves-Perthes disease. This disease causes bone death of the ball of the hip joint. People with this disease have less blood flow to the hip joint. This bone death causes the joint to degrade. Even after the body recovers and resupplies the area with blood, the ball joint may no longer be the same shape. If this change to the joint causes decreased hip mobility, there may be out-toeing.

Symptoms of Out-Toeing

The main symptom of out-toeing is that the toes point away from the body, to the side, when your child stands. For most children, this does not pose a problem. However, some children with out-toeing have pain, limping, or other discomfort.

If there is pain caused by out-toeing, it may be felt anywhere in the leg, knee, hip, or foot.

Diagnosis and Treatments for Out-Toeing

Most toddlers have at least slight in-toeing or out-toeing. It usually goes away with time, as your child gets more experienced with walking. However, if it doesn’t go away or causes your child distress, it may be time to see your doctor.

To diagnose your child, your doctor will perform a physical exam. They will watch your child walk and run. They will examine the legs and joints. They may also do a neurological exam or take X-rays to rule out any other conditions.

Treatment for out-toeing depends on the cause. Most cases resolve on their own. However, your doctor might recommend surgery in some cases. Most cases of out-toeing caused by tibial torsion do not get better with time. They may actually get worse if left untreated. These cases are more likely to require medical treatment.

Surgery for out-toeing can reduce the twist in the bones or joints and straighten the toes so they point straight ahead, leading to a more comfortable and easier gait.

If you are allowing the condition to resolve on its own, some doctors recommend tracking progress by taking videos. This is easier than ever now that most parents have a smartphone that records videos. You can take videos a year apart and compare them to make sure your child’s gait is improving over time, and not getting worse or just staying the same.

Past treatments for both in-toeing and out-toeing included leg braces. However, studies show they do not help the condition go away more quickly in those who do recover on their own. Braces, shoes, and visits to the chiropractor also do not help cases of out-toeing caused by tibial torsion. Now, doctors rarely use braces to treat these conditions.

Studies show that after treatment, most children go on to have normal lives. They can play sports and live pain-free. Only one out of every 1,000 kids with out-toeing has residual pain or discomfort that requires further treatment. However, your child may be more prone to knee and hip pain.

Similar Conditions

Being bow-legged or knock-kneed are similar conditions to in-toeing and out-toeing. However, those conditions have to do with the curvature of the legs. If your child is bow-legged, their legs curve out at the knee. Children who are knock-kneed have legs that curve in at the knee. Similar to being out-toed, these conditions usually improve over time without treatment.

When to Contact Your Doctor for Out-Toeing

Talk to your doctor about your child’s out-toeing if it hasn’t gotten better by the time they turn three years old, or if it keeps getting worse instead of getting better. You should also contact your doctor if your child misses developmental milestones in addition to out-toeing.

If one foot’s out-toeing is worse than the other’s, or if your child has a limp or says their legs hurt, you should also contact your doctor.

Show Sources

American Orthopaedic Foot and Ankle Society FootCareMD: “INTOEING AND OUTTOEING.”

KidsHealth: “In-toeing & Out-toeing in Toddlers.”

Mayo Clinic: “Legg-Calves-Perthes disease.”

Nicklaus Children’s Hospital: “Out-Toeing.”