All About Out-Toeing

In pediatrics, out-toeing is a less common concern than in-toeing, but it is still a gait deviation found in many young children.

Common reasons why a child might out-toe include:

• Tight hip external rotator muscles: children are born with their hips positioned out wide, and their muscles may become tight in this position, resulting in their legs turning outwards

• External tibial rotation or femoral retroversion: the opposite of femoral anteversion in the “pigeon-toed” post, in which the shin bone is twisted outwards or the hip is positioned in a way that makes the whole leg point outwards

• Flat feet (pronation): the most common reason why a child might walk with their toes pointed outwards

• Low muscle tone (hypotonia) or increased joint flexibility (hypermobility) through the foot and ankles

External tibial torsion and femoral retroversion will usually self-correct by around 8-10 years old without intervention, but therapists may sometimes recommend hip stretches or alternative sitting positions to decrease the amount of out-toeing. Out-toeing due to flat feet/ankle pronation will usually begin to resolve itself after the development of the child’s foot arch (around 3 years of age and mostly formed by 5-6), but a physical therapist may recommend calf stretching exercises and walking around barefoot to promote arch development.

Overall, mild out-toeing (especially in the early walking stages) is a normal walking pattern for many children and shouldn’t be cause for alarm. Up to 20 degrees of out-toeing can be normal in adults. However, if your child is experiencing pain or swelling throughout their legs and/or feet, walks with a limp, is asymmetrically out-toeing, or is limited in their ability to move around, contact us to see how we can help!