What is Out-Toeing?
Out-toeing is an abnormal condition characterized by the toes or foot pointing in an outward direction rather than straight ahead while standing or walking. It is usually noticed at an early age when a child starts walking and normally resolves on its own, but it may persist into adulthood and can sometimes cause pain and disability.
Causes of Out-Toeing
Out-toeing can affect children of all ages for various reasons. The most common factors associated with out-toeing include:
- Family history of out-toeing
- Abnormal fetal position
- Congenital bone deformity
- Flat feet
- External rotation of the hip (hip twisting outwards)
- External torsion of the tibia (shinbone twisting outwards)
- Femoral retroversion (thighbone twisting outwards)
- Slipped capital femoral epiphysis (the femoral head slips backward in relation to the rest of the femur)
- Neurological disorder
- Abnormal growth
Out-toeing in adults can be caused by:
- Injury to the leg, hip, ankle, or foot
- Muscle tightness in the legs or hips
- Poor posture
Symptoms of Out-Toeing
Out-toeing is normally painless. It is easy to recognize because the child develops a waddling gait (rocking from side to side) with the feet turned out, though mobility is not affected. If the condition does not resolve with growth there may be limping or pain in the hip, thigh, knee, or foot.
Diagnosis of Out-Toeing
Your doctor will review your child’s symptoms, medical history, and growth. A thorough physical examination of the legs, hips, and feet is performed checking range of motion, tightness, lack of flexibility, and the way your child walks and runs. Nerve and muscle function and coordination are all checked during a neurologic examination. Imaging tests such as X-rays or an MRI may be ordered if a serious condition is suspected.
Treatment for Out-Toeing
Treatment for out-toeing may be necessary depending on the cause. Out-toeing usually resolves before a child reaches the age of three. If the out-toeing was caused by a prolonged fetal position or the bones in the body growing at different rates, it should resolve over time.
If flat feet are the cause, orthotics and supportive footwear are recommended to correct the foot alignment. Orthotics are not a cure, but they can help correct mild out-toeing caused by ligament laxity in the foot and ankle. Any muscular contractures or muscular weakness can be treated using physical therapy, including a stretching and strengthening program.
Surgical correction is an option if out-toeing is severe, painful, and not responding to conservative treatment. It may be performed to treat bone deformity such as tibial torsion, femoral retroversion or to treat a slipped capital femoral epiphysis.
