outtoeing

Outtoeing, or toe-out, is a condition in which the feet point outward relative to the line of travel. It is commonly observed in infancy and early childhood. In most children, the condition is temporary and improves with growth. Persistent toe-out that remains beyond preschool years may require evaluation.

The most common cause in children is external tibial torsion, where the shinbone is rotated outward. Other causes include excessive external rotation of the femur, foot deformities such as metatarsus adductus (though this more often causes toe-in), muscular imbalances, or differences in leg length. In adults, toe-out can result from hip or knee arthritis or previous injuries.

Diagnosis is based on clinical examination. A clinician examines limb alignment during standing and walking, and may perform the thigh-foot angle test to assess tibial torsion. Imaging, such as X-rays, is not routinely needed but may be used if there is persistent deformity, pain, or functional limitation to measure torsion.

Treatment typically centers on observation and reassurance, as many cases improve with growth. When necessary, treatment may include physical therapy with stretching and strengthening, activity modification, or orthotic devices. In rare cases where external tibial torsion is severe and causes functional problems, surgical realignment, such as a tibial derotation osteotomy, may be considered after thorough evaluation.

The majority of children outgrow toe-out as leg bones rotate and grow. Early referral is advised if toe-out is associated with pain, rapid progression, limb length discrepancy, or abnormal gait.