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What to Know About Out-Toeing

Medically Reviewed by Dan Brennan, MD on June 01, 2021

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.

WebMD Medical Reference

Sources

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."

OrthoKids: "Out-Toeing."

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