The term “slew-footed” is a common, non-medical way to describe “out-toeing,” also known as “duck-footed.” This condition causes the feet to point outward instead of moving straight ahead during walking or standing. Out-toeing is considered a normal developmental variation, particularly in infants and young children, resulting from a rotational difference in the bones of the lower leg. While it often resolves without intervention, understanding the underlying cause is important.
Identifying Out-Toeing
Out-toeing is visually defined by the angle of the foot relative to the line of progression (the direction of travel). This angle, known as the Foot Progression Angle (FPA), is measured by observing the alignment of the feet or using a footprint. In out-toeing, the feet turn outward, away from the body’s midline. The condition is considered significant when the outward angle exceeds the normal range, such as over 20 degrees in infancy or 15 degrees in older children. The outward pointing of the feet is usually most noticeable when a child is learning to walk or running, as movement exaggerates the rotational difference.
Primary Causes and Developmental Factors
The outward rotation that causes out-toeing originates from three anatomical areas: the thigh bone, the shin bone, or the foot itself. The most common cause in toddlers is a persistent external rotation contracture of the hip, stemming from the baby’s position inside the womb. This contracture typically resolves spontaneously as the child begins to stand and walk, usually normalizing within the first two years of life.
Femoral Retroversion
One specific cause is femoral retroversion, an outward twisting of the femur (thigh bone) relative to the hip joint. This condition causes the entire leg to point outward from the hip down. Femoral retroversion tends to improve naturally as the child grows.
External Tibial Torsion
External tibial torsion involves an outward twist in the tibia (shin bone) between the knee and the ankle. This rotation is often observed in children between four and seven years old. External tibial torsion may not resolve on its own as consistently as other forms and can sometimes worsen slightly with age.
Pes Planus (Flexible Flat Feet)
A third factor is pes planus, or flexible flat feet, which can create the appearance of out-toeing due to the collapse of the foot’s arch. When the arch flattens, the foot rolls inward, making the toes and forefoot appear to point outward. This presentation is common in babies and toddlers whose arches have not yet fully developed.
Impact on Gait and Movement
Out-toeing generally does not cause pain or limit the ability to participate in physical activities. The condition can alter walking mechanics, which may result in a slightly waddling or clumsy gait. This altered foot placement can increase the likelihood of tripping or falling, especially when running.
Out-toeing changes the mechanical loading, or stress, placed on the joints of the lower body. The outward rotation can affect the alignment of the knees and hips, potentially contributing to knee pain in more severe or persistent cases. The way the feet strike the ground also changes, sometimes leading to uneven wear on the outer edges of shoes.
Management and When to Seek Professional Help
For many developmental cases of out-toeing, the standard approach is “watchful waiting,” as the body’s natural growth process corrects the rotation over time. This approach is recommended if the child is not experiencing pain or functional limitations. Encouraging active play and a variety of movement patterns supports the natural resolution of the condition.
A consultation with a pediatrician or orthopedic specialist becomes appropriate if the out-toeing is unilateral (affects only one leg) or if it is worsening significantly. Professional evaluation is also necessary if the condition is accompanied by pain, limping, or if it interferes with the child’s ability to walk, run, or keep up with peers. Management options for persistent cases may include physical therapy to address muscle weakness or tightness that contributes to the rotation. In rare, severe instances causing significant functional impairment, a surgical procedure to realign the bone may be considered after skeletal maturity.