Out-toeing, also known as external rotation or duck feet, is a condition where the feet point outward instead of straight ahead when walking or running. It's a common concern among parents and caregivers of young children but can persist into adulthood in some cases.
There is no known reason as to why out-toeing exactly occurs but below are some factors that contribute to it
1. Muscle Weakness or Imbalance: Weakness or imbalance in the muscles of the hips, thighs, or lower legs can lead to out-toeing. This imbalance affects the alignment of the feet during walking.
2. Bone Structure: Sometimes, the shape or structure of the bones in the legs or feet can contribute to out-toeing. This might include conditions like external tibial torsion (twisting of the shin bone).
3. Position in the Womb: The position a baby assumes in the womb can also influence the development of out-toeing. Babies who spent a significant amount of time in a certain position may be more prone to develop this condition.
1. Outward Pointing Feet: The most obvious symptom of out-toeing is the outward pointing of the feet during walking or standing.
2. Gait Abnormalities: Individuals with out-toeing may exhibit an abnormal gait, such as walking with a waddle or appearing clumsy.
3. Potential Pain: In some cases, out-toeing can lead to discomfort or pain, particularly in the hips, knees, or feet, due to the abnormal stress placed on these joints.
Diagnosis of out-toeing typically involves a physical examination by an Orthopaedic surgeon or Paediatrician.
Examination includes observing the patients gait, foot alignment, performing a rotational assessment and examining the hips, knees, ankle and feet. Imaging is not always required but if required specialised X-rays and CT scans are requested to assess the rotation of the lower limb.
1. Observation: In many cases, out-toeing resolves on its own as a child grows and develops. Observation by a healthcare provider may be all that's needed, with no specific treatment required.
2. Physiotherapy: For cases where muscle weakness or imbalance is contributing to out-toeing, physical therapy exercises can help strengthen the appropriate muscle groups and improve alignment.
3. Orthotic Devices: In some instances, orthotic devices such as shoe inserts or braces may be recommended to provide support and encourage proper foot alignment. Orthotics however will not correct the abnormal rotation of the bones.
4. Surgery: Surgery is rarely needed for out-toeing and is typically only considered in severe cases that do not respond to conservative treatments. Surgical options may involve correcting bone alignment or addressing underlying structural issues.
Most patients who out-toe do not require any intervention and have a great prognosis. They are able to participate in all activities and sports they wish. The more severe cases that require surgical intervention also have a good outcome once recovered from the surgery with improvement on the alignment or appearance of the limb and function.
While some causes of out-toeing, such as bone structure, cannot be prevented, there are some steps that may help promote healthy foot alignment:
- Encourage regular physical activity to promote muscle strength and balance.
- Ensure children wear properly fitting footwear that provides adequate support.
- Avoid excessive use of baby walkers, as they can interfere with natural walking development.
Out-toeing is a common condition that usually resolves on its own as a child grows. However, it can sometimes persist into adulthood or cause discomfort in some cases. Early diagnosis and appropriate interventions, such as physiotherapy can help manage symptoms.
For personalised advice and treatment options, individuals with concerns about out-toeing should arrange an appointment with Dr Shales
