Out toeing

What is out-toeing in children

A child who out-toes is one whos foot points away from the body when they walk or run. Out-toeing occurs in most children at some point, as they grow up this is a natural part of development and is usually grown out of by the age of about 3. Although, there are a few serious conditions that can lead to out-toeing. Out-toeing may be due to twist in the bone in the hip, thigh bone, shin bone or foot.

What causes out-toeing in children?

Out-toeing may be a result of the bony structure in the foot or anywhere in the lower limb, it is often hereditary, or sometimes it can be the result of an underlying condition.

Structural

External rotation contracture of hip.

When a baby is in womb, they lie in a position with their hips in an up and outwards tilted position. Therefore they are born with their hips in this position, this should reduce gradually as they start walking.

External tibial torsion

Where the lower end of the shin bone is in an out-turned position in relation to the upper end near the knee. This is due to positioning within the womb, and does not reduce with development and can worsen with age.

Femoral retroversion

Is the description used for a thigh bone which lies in a naturally out-turned position compared to hip, similar to external tibial torsion it is due to the positioning in the womb.

Flat feet

A foot that is flat or with little arch can give the appearance that the child is out toeing. Flat feet in babies and toddlers is normal, the fatty padding around the bottom of the feet can give this appearance, the arch usually develops therefore intervention is rarely advised.

Pathological

Slipped upper femoral epiphysis.

This occurs due to trauma to to the growth plate at the hip and displation of the hip joint, leading to out-toeing on one side. This may cause a child to limp and complain of pain around the groin area. As soon as a diagnosis of SUFE is made, surgical intervention is nearly always indicated shortly after, to prevent deterioration of the joint.

Cerebral palsy

Muscle imbalance that occur in those with cerebral palsy, may lead to out-toeing that is usually one-sided. Children with suspected cerebral palsy will be referred onto a paediatric neurologist to investigate further.

What are the signs and symptoms of out-toeing?

The visual observation of the foot pointing outwards when walking or running. This may be symmetrical or asymmetrical.

When should I seek advice?

• If the out-toeing is asymmetrical
• Child complaining of pain
• Sudden onset of out-toeing
• Child limping
• Child struggling to perform exercise/activities
• Out-toeing that is worsening not improving

Benefits of podiatry for a child that out-toes

• The benefits of podiatry for a child that out-toes may be:
• Education
• Advice
• Referral where appropriate
• Orthotics
• Diagnosis of the primary cause

What would podiatry for my child's out-toeing involve?

If there are concerns about the way a child walks then visit our clinic. Most children who out-toe following the age of around 3 will continue to do so into adulthood, a lot of the time it is benign therefore intervention may not be required.

If you are concerned about your child's out-toeing and would like them to be seen by a professional, a podiatrist will provide a biomechanical assessment; in which your child's lower limb will be thoroughly examined to determine the route of the cause resulting in the out-toeing. Not all cases of out-toeing are treatable, those that are may benefit from orthoses. Very rarely, in severe cases of out-toeing surgery may be suggested.

If you would like your child assessed visit Liverpool Podiatry. We have podiatrists who are trained in the assessment, diagnosis and treatment of a wide range of foot pathologies.