| Outtoe Gate
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Outtoe Gate

Outtoeing is an externally rotated appearance of the child’s feet when he or she walks, which gives it a turned out look. This is often due to an abnormal growth or underlying neurological problem. Also called duck feet, outtoeing is less common than intoeing, and it can lead to significant disability and pain as the child grows into an adult.


Does flatfeet cause outtoeing?


Pes planus (flatfeet) occur when the child has little or no arch in the foot. Because an arch isn’t formed, the feet appear to turn to the outside. Children who have outtoeing due to flatfeet rarely have pain or other symptoms, as with other causes of the condition.


How does external tibial torsion affect the feet?


Another cause of outtoeing is external tibial torsion. This is an outward twisting of the leg bone (tibia), which occurs in late childhood or early adolescence. External tibial torsion often affects only one leg, but it can affect both. People with external tibial torsion often have pain at the front of the knee.


Does hip contracture cause outtoeing?


With fetal development, the position of the child in the uterus affects the hips. The hips are also constrained in a tight position right after birth, which worsens the problem. External hip contracture usually resolves by itself, but this varies among children. When persistent hip tightness occurs, the child’s feet turns out with walking. Most babies are also flat-footed, so the outtoeing hard to detect. Most children do not require treatment for this condition, as it resolves on its own.


Does femoral retroversion cause outtoeing?


Femoral retroversion occurs when the thigh bone (femur) is angled back in relation to the hip joint. This condition causes the entire lower extremity to deviate to the outside. Most often seen in obese children, femoral retroversion can lead to hip arthritis later in life.


How is outtoeing treated?


In contrast to intoeing, special shoes, braces, chiropractic manipulation, and physical therapy do not resolve outtoeing. Most patients have spontaneous resolution of the condition by age ten. To correct the problem, the orthopedic surgeon may perform a surgical procedure called an osteotomy, which involves cutting and rotating the bone into a normal position.


When should I have my child evaluated by a doctor?


You may need to have your child evaluated by a doctor if you notice:

  • Outtoeing that does not resolve or improve by age 3-4 years
  • Limping and/or complaints of hip/leg pain
  • Developmental delays
  • One foot that turns outward and the other that is in normal position
  • Gait abnormalities that worsen over time


Are orthotic devices useful for outtoeing problems?


Orthotic devices have been proven effective for outtoeing in children. Corrective shoes and orthotic devices with an outtoeing wedge were found to significantly increase normal gain in children with outtoeing.


What is the difference between knock-knees and bowlegs?


Genu varum (bowleg) is seen in children ages 0-2 years of age, whereas genu valgum (knock-knees) peaks from 2-4 years of age. With bowlegs, the knees are farther apart, giving the legs a bowed appearance, whereas with knocked knees the knees are close together.



Munuera PV, Castillo JM, Dominguez G, & Lafuente G (2010). Orthotic devices with out-toeing wedge as treatment for in-toed gait in children. J Am Podiatr Med Assoc, 100(6), 472-478.

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