Video Explanation: Out-toeing – What Parents Need to Know

Out-toeing, commonly called "walking with feet turned outward" or "duck-footed," is less frequent than in-toeing but equally a source of concern for parents. Like in-toeing, in most cases it's a normal developmental variant. **Main causes:** 1. **External tibial torsion:** The tibia is rotated outward. It's the most common cause and tends to reduce spontaneously with growth, though more slowly than internal torsion. 2. **Femoral retroversion:** The femur is rotated outward. Less common but can be more persistent. 3. **Flatfoot:** A very flat foot can give the impression of out-toeing due to its "collapse" inward. 4. **Hip contracture:** In newborns and first months, a slight contracture of hip external rotators can cause out-toeing, which resolves with growth. **When it's normal:** In the first months of life, some out-toeing is physiological (legacy of fetal position). Even after age 2, mild out-toeing can be a normal variant, especially if symmetrical and not associated with symptoms. **Attention to "W-sitting":** Children with out-toeing often sit in "W" position (knees together, feet out). Although this position has been demonized, it generally doesn't cause problems if not excessive. The important thing is that the child can also sit in other ways. **Functional consequences:** Out-toeing is generally well tolerated and rarely limits activities. It may confer an advantage in some sports (classical dance, breaststroke swimming).