Out-Toeing
Out-toeing, where a child’s feet point outward rather than straight ahead, is less commonly discussed than in-toeing but just as often a normal part of growth.
At Emerald Hill Podiatry, we also look closely at foot structure when assessing out-toeing, since it’s frequently linked to flat feet, a connection many parents aren’t aware of until it’s explained during an assessment.
What Is Out-Toeing?
Out-toeing describes a walking or standing pattern where one or both feet turn outward instead of pointing forward. It can be noticed from the toddler years through to later childhood, and while the outward angle of the feet is what parents usually spot first, out-toeing often has as much to do with the arch of the foot as it does with the angle of the leg.
How Leg Rotation Creates the Outward Turn
Out-toeing can stem from rotation anywhere along the leg, and identifying where helps explain why it’s happening:
- External tibial torsion — an outward twist of the shin bone
- Femoral retroversion — an outward rotation of the thigh bone at the hip
- Flat feet (pes planus) — a collapsed or low arch that causes the foot to roll inward (overpronate), which in turn rotates the leg and makes the foot point outward as a compensation
Flat feet are one of the most common and frequently overlooked contributors to out-toeing. Because the connection isn’t obvious just from looking at the feet, what appears to be a leg rotation issue is often, at least in part, a foot structure issue, and the two need to be assessed together.
The Natural Course Through Childhood
Much of the rotational component of out-toeing tends to improve naturally as a child grows, in the same way in-toeing often does. However, out-toeing linked to flat feet doesn’t always resolve on its own in the same way, since the arch itself may need support to develop properly or may persist into adulthood if left unaddressed. This is part of why out-toeing benefits from a slightly different monitoring approach than in-toeing, one that keeps an eye on both leg rotation and how the arch is developing over time.
When to See a Podiatrist
See a podiatrist if:
Your child's feet appear flat in addition to turning outward
The out-toeing seems to be worsening rather than improving with age
Your child reports pain or discomfort in the feet, legs, or knees
You notice a significant difference between the left and right foot
You'd like a clear assessment of whether the cause is rotational, structural, or both
Get Your Foot Properly Assessed
Help Your Child Find a Balanced and Steady Gait
Because out-toeing can stem from leg rotation, flat feet, or a combination of both, treatment is tailored to what’s actually driving it.
Options include:
- Gait Assessment — identifies whether the out-toeing is coming from the hip, shin, or foot arch, and how it's affecting your child's walking pattern
- Exercises and Activity Guidance — supports healthy leg and foot development through the growing years
- Monitoring Through Growth — periodic review to track whether the pattern is resolving naturally or needs further support
- Ankle Foot Orthosis (AFO) — a supportive brace used in more pronounced cases, particularly where flat feet are contributing significantly to the outward turn, helping guide the foot and ankle into better alignment during growth
What to Expect at Your Assessment
Your podiatrist examines your child’s foot arch, leg rotation, and walking pattern to determine whether the out-toeing is primarily structural, rotational, or a combination of the two. Because flat feet are such a common but easily missed contributor, this distinction shapes the whole treatment approach.
