Out-toeing, commonly called duck-footed or slew-footed, occurs when a person’s feet point outward instead of straight ahead. While often harmless and a natural part of childhood development, persistent out-toeing can lead to discomfort, mobility issues, and even long-term joint problems. Orlin & Cohen’s physical therapists, Jessica Tuckruskye and Nicole Elanbeck, are here to help you understand its causes, symptoms, and treatment options to help determine when intervention is necessary.

What Is Duck-footed, Slew-footed, or Out-toeing?

Out-toeing is a condition where the feet turn outward rather than aligning forward. It is the opposite of in-toeing (pigeon-toed), where the feet point inward. In many children, mild out-toeing resolves naturally by ages six to eight as they grow and develop. However, if it persists or worsens, it may require medical attention to prevent future orthopedic issues.

Causes

There are several reasons why someone may be duck-footed, including:

Genetics: Family history plays a role in foot positioning and gait.

Fetal positioning: The position of a baby in the womb can affect how their legs develop.

Infant resting position: How a baby naturally rests their legs during infancy can contribute to out-toeing.

Joint mobility issues: Excessive hip joint flexibility can lead to improper foot alignment.

Structural conditions: External tibial torsion, femoral retroversion, or flat feet (pes planus) may cause out-toeing.

Neuromuscular disorders: Conditions like cerebral palsy (CP), slipped capital femoral epiphysis (SCFE), and Legg-Calvé-Perthes disease can also contribute to out-toeing.

Muscular imbalances: Weak or tight hip muscles, including the gluteus medius and tensor fascia lata (TFL), can cause external rotation of the legs.

Understanding the root cause of out-toeing helps determine the most effective treatment approach.

Symptoms

While many children and adults with out-toeing experience no pain, some may develop issues over time, such as:

Waddling gait: A noticeable outward rotation of the feet, more visible when running.

Balance issues: Difficulty maintaining proper stability when walking or playing sports.

Chronic knee or back pain: As the body compensates for poor foot alignment, it may strain other joints.

Early recognition of symptoms can help prevent future complications.

Treatment (How to Correct Duck Feet)

Most individuals do not require treatment for out-toeing. However, if it causes discomfort or affects mobility, several approaches can help improve foot alignment.

Orthotics for Duck-footed, Slew-footed, or Out-toeing

Orthotic inserts, braces, and proper footwear can provide better stability and support for individuals with out-toeing. These solutions help control foot positioning and reduce excessive outward rotation. Avoid high heels and stiff-soled shoes, as they can worsen alignment problems.

Physical Therapy

A structured physical therapy program can help strengthen weak muscles, improve flexibility, and retrain gait mechanics. Key therapy components include:

Hip strengthening exercises: Targeting the gluteus medius for improved stability and alignment.

Stretching: Loosening tight muscles, including the hip flexors, adductors, gastrocnemius, soleus, and TFL, may contribute to out-toeing.

Proprioceptive training: Single-leg balance exercises and gait retraining can increase awareness of foot positioning.

Soft tissue mobilization & myofascial release: Hands-on therapy techniques to reduce discomfort caused by altered walking patterns. Myofascial release specifically involves applying gentle, sustained pressure to the fascia (connective tissue) surrounding muscles to relax tight areas, restore mobility, and relieve pain.

Early intervention is key for children, as their muscles and bones are still developing and can adapt more easily to corrective exercises.

Operative Treatment

Surgical intervention may be considered in rare cases where conservative treatments do not correct out-toeing. An orthopedic surgeon may perform a rotational osteotomy, where the femur or tibia is surgically repositioned to achieve proper alignment. Metal implants, such as pins, plates, or screws, hold the bones in place during healing. This option is generally reserved for severe cases causing pain or functional impairment.

Talk to a Specialist

While mild out-toeing is often harmless, those experiencing persistent symptoms or discomfort should seek a professional evaluation. At Orlin & Cohen, our fellowship-trained orthopedic specialists provide expert diagnosis and personalized treatment plans to address out-toeing and other gait abnormalities. Whether through physical therapy, orthotics, or surgical intervention, we’ll help you achieve optimal mobility and comfort. Schedule an appointment today to take the first step toward better movement and long-term joint health.