Parents often watch how their children walk and grow. Some kids walk with their feet pointing outward instead of straight ahead. This is called “out-toeing” or sometimes “duck feet.” Let’s learn about why this happens and when you might need to talk to see a physical therapist.
What is Out-toeing?
Out-toeing is when a child’s feet point outward when they walk or stand. Some out-toeing is normal, especially when kids are young. But if it’s very noticeable or doesn’t get better as they grow, it might need attention.
Why Do Kids Out-toe?
Weak Hips and Core
Many kids out-toe because certain muscles in their hips and core are weak.
Why this causes out-toeing:
- When side hip muscles are weak, turning the feet out makes walking more stable
- Kids naturally find the position that helps them balance better
- Out-toeing creates a wider standing base, which helps them stay balanced
You might notice kids who out-toe also:
- Sit in a “W” position (with legs bent and feet outside their hips)
- Lean on furniture when standing
- Get tired quickly during active play
- Have trouble standing on one leg
Exercises that make hip and core muscles stronger can help fix this type of out-toeing.
Flat Feet
Some kids have flat feet that roll inward when walking. This is called “pronation.”
When a child’s foot rolls in too much:
- The arch of the foot flattens
- The heel tilts inward
- The front of the foot turns outward to help with balance
Good shoes with arch support can help this type of out-toeing. Sometimes special inserts for shoes (called orthotics) might be needed.
How Pronation Can Change Bone Growth
When children have flat feet that roll inward (pronation) for a long time, it can actually change how their leg bones grow. This is important to understand:
- Twisting Forces: When feet roll in too much, it creates twisting forces up the leg
- Growing Bones: Children’s bones are still growing and can be shaped by these forces
- Tibial Torsion: The shin bone (tibia) is most commonly affected and may start to twist outward over time
- Permanent Changes: If this happens for years during growth, the bone can actually grow in a twisted position
This is why treating pronation early can be important. Proper arch support from good shoes or inserts can help prevent these bone changes from happening.
Bone Position
Sometimes out-toeing happens because of how the leg bones are positioned:
- Outward-Turned Thigh Bone: The thigh bone (femur) might naturally turn outward more than usual.
- Outward-Turned Shin Bone: The shin bone (tibia) might twist outward too much.
Problems with bone position usually can’t be fixed with exercises, however exercises can help your child improve their strength and stability if you are noticing that they are having trouble keeping up with their peers or falling a lot.
When to See a Physical Therapist
Consult with a pediatric physical therapist if you notice:
- One foot turns out much more than the other
- Walking seems painful
- Your child trips or falls often
- Out-toeing gets worse instead of better
- Your child has other delays in development
- They are consistently turning their toes out after they have been independently walking for > 2 months
How to Help Out-toeing
The right treatment depends on what’s causing the out-toeing:
For weak hip muscles:
- Fun exercises to make side hip muscles stronger
- Core strengthening activities
- Balance games like standing on one foot
- Activities that teach proper alignment
For flat feet:
- Supportive shoes with good arch support
- Sometimes special shoe inserts
- Exercises to strengthen foot arches
For bone position issues:
- Proper foot alignment
- Strengthening to help the secondary effects of out toeing
- In rare, severe cases that cause problems, surgery might be needed after age 8-10
The Future for Kids with Out-toeing
Good news! Out-toeing can be helped especially if addressed early!
However, severe out-toeing that isn’t addressed might sometimes lead to:
- Less efficient walking
- Extra stress on joints, especially knees and ankles
- Higher chance of certain injuries during sports
What Parents Should Know
Out-toeing happens for different reasons, from weak muscles to how bones are positioned. Understanding why it’s happening helps find the right solution.
The most important thing is to focus on your child’s overall development. A child who is active, developing normal motor skills, and has no pain is likely doing well, even with some out-toeing.
If you’re worried about how your child walks, talk to a pediatric physical therapist. Getting help early often leads to the best results.
Please contact us for a consultation if you have concerns about your child’s development.