A Out Toeing

A-Out-toeing
Introduction
Out-toeing is when your child’s foot points outward instead of straight ahead when he
or she runs or walks. While out-toeing is often normal and will correct on its own, there
are some conditions that cause out-toeing that are serious. Out-toeing is much less
common than in-toeing and can occur in older children. Out-toeing can also run in
families.
Description
Out-toeing may be due to twists in the bone in the hip, thigh bone (femur), shin bone
(tibia), or foot. While some of these are normal variations, a thorough history and
examination are needed to make sure there is not a more serious problem.
Common causes of out-toeing:

External rotation contracture of the hip – During pregnancy, both of the baby’s hips are
flexed up and rotated outward to fit in the mother’s womb. This position is known as
hip external rotation (the feet are pointed inwards). This external rotation contracture
present at birth usually goes away on its own when the child starts walking.
External tibial torsion – This is when the shin bone (tibia) is twisted outward. Similar to
the external rotation contracture of the hip, external tibial torsion is also usually due to
positioning of the baby in the womb. However, unlike an external rotation contracture
of the hip, external tibial torsion usually does not improve and may even get worse as
the child grows. Splints, braces, special shoes, or chiropractic manipulation do NOT
improve external tibial torsion.
Flat feet – flat feet (link) occur when there is no arch in the foot. This can give the
appearance of out-toeing. Flexible flat feet are normal in babies and toddlers. Out-
toeing from flat feet usually improves on its own without treatment.
Less common causes of out-toeing
Femoral retroversion – This is when the thigh bone (femur) has a twist outward
compared to the hip. This is more often seen in obese children. It can also be seen in
slipped capital femoral epiphysis (SCFE) (link) in older children and adolescents.
Legg-Calve-Perthes (LCP) – because of decreased hip rotation, some patients with

LCP may present with out-toeing.
Cerebral palsy (CP) – muscle imbalance in the legs of children with Cerebral Palsy can
lead to out-toeing. This is usually seen on one leg only, not both. A thorough history
and physical exam may reveal signs of possible Cerebral Palsy, and referral to a
neurologist or physical medicine and rehabilitation specialist is usually needed.
Symptoms
Many children with out-toeing have no pain or functional problems. Frequently,
families notice that the child stands, walks, or runs with the feet point outward.
Depending on the reason for the out-toeing, some children may limp and/or have pain
in the hip, thigh, knee, or foot.
Examination
Your doctor will take a thorough history, especially regarding birth history and
developmental milestones. Any history of pain or limping should be discussed. The
physical exam will include watching your child walk and run, and checking range of
motion of the hips, knees, ankles, and feet. He or she will also do a neurologic
examination to check muscle tightness, nerve / muscle function, and coordination.
Other Studies
If the history and physical examination are consistent with out-toeing as normal
development in your child, no other studies are needed. If your doctor finds anything
concerning, he or she may order x-rays or refer your child to a specialist.
Treatment
Treatment is dependent on the underlying diagnosis that is causing the out-toeing.
Normal developmental out-toeing can be followed by your child’s pediatrician or
family doctor. Occasionally, external tibial torsion or femoral retroversion may require
surgery to untwist the bones if the out-toeing causes pain, limping, knee cap (patella)
problems, or severe problems with walking and running when the child is older. It is
important that your child’s doctor evaluates your child to make sure that there are not
other serious things like SCFE (link), LCP (link), or CP (link) that are causing the out-
toeing.
Outcome
Even though normal developmental out-toeing may not completely correct with growth,
almost all children are pain free and can participate in sports and activities. Although
patients with external tibial torsion and femoral retroversion may have an increased risk
of hip or knee pain, long term functional problems only occur in about 1 in 1,000
children (Ref – Staheli L “Rotational problems in children.” Instructional Course
Lecture 1994; 43: 199-209.)
https://orthokids.org/conditions/out-toeing/

A Out Toeing

Uploaded by

Copyright:

Available Formats

A Out Toeing

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

A Out Toeing

Uploaded by

Copyright:

Available Formats

A-Out-toeing

Common causes of out-toeing:

Less common causes of out-toeing

Legg-Calve-Perthes (LCP) – because of decreased hip rotation, some patients with

You might also like