Is your child walking with Pigeon Toes (in-toeing) or Duck Feet (out-toeing)?

When children learn to walk, they may develop multiple different walking styles and habits. The most common deviation noticed by physiotherapists are in-toeing (pigeon toed) and out-toeing (duck walk).


What is an Out-Toeing?

Out-toeing is a form of gait pattern that causes a child’s feet to turn outwards when walking. Causes of out-toeing can be from muscle imbalances, skeletal changes/abnormalities, or neurological changes.

If there are imbalances in the muscle length or strength, this can result in an outward rotation of the femur (thigh bone).

Skeletal changes/abnormalities may structurally have an outward rotation of the femur (thigh bone) in the hip (femoral retroversion) or outward rotation of the tibia (shin bone) from the knee (external tibial torsion).

Some neurological conditions may result in muscle weakness, high/low tone, or flat feet resulting in an increased risk of out-toeing.


What is an In-Toeing?

In-toeing is a form of gait pattern, where a child turns their feet inwards whilst walking (pigeon toed).

Like out-toeing, this style of gait may be caused by imbalances of muscular strength or length, skeletal changes/abnormalities, or some neurological conditions.

When a child in-toes, it may be due to a structural inward rotation at the joint of the femur (thigh bone) creating femoral anteversion, or tibia (shin bone) creating an internal tibial torsion.

In-toeing may also be caused by muscular imbalances resulting in an inward rotational pull of the femur, or weakness of the external (outward) rotational muscles.

Neurological conditions (usually children with high tone) can also present with in-toe gait patterns, due to tight postural muscles and difficulties with foot placement during gait.


Physiotherapy can help to address and normalise different gait patterns.


Below is a list of some easy exercises you can practice with your child at home to work on their strength and flexibility to help with normal gait movements.

Out-Toeing Exercises (Duck-Feet)

  • To strengthen the hip muscles, complete some squats whilst trying to keep a ball squeezed between the knees/thighs.
  • Walking along a balance bean, straight line or curb to encourage ‘toes forward’ walking.
  • Standing on one leg (toes pointing forwards) for as long as you can, on both sides.
  • Encourage your child to walk while rotating their hips and feet inwards so their toes are facing forward when walking
  • Frog jumps along a hallway


In-Toeing Exercises (Pigeon-Toed)

  • Kicking a ball with the inside portion of their foot, so their leg is rotated outwards
  • Frog jumps along a hallway
  • Penguin walking (turning the feet out) along a hallway
  • Walking along a balance bean, straight line or curb to encourage ‘toes forward’ walking.
  • Squats whilst keeping a ball squeezed between the knees/thighs whilst keeping the toes pointed slightly outwards.
  • Stretching the inside of thigh muscles, whilst sitting, place the feet together, and let the knees fall out to the side (like a butterfly)


Is your child in-toeing or out-toeing?

If you are concerned about your child’s walking patterns, or their walking is impacting on their safety at home, school or in the community (recurrent trips and falls), it may be necessary for your child to have a review with a paediatric physiotherapist. This will allow for an accurate physiotherapy assessment to take place and a customised home exercise program for your child.

Whilst it can be a normal variation for in-toeing and out-toeing to occur in childhood, it is not normal for children to have out-toeing or in-toeing on only one side. If this is occurring, it is recommended that your child have an assessment by a trained professional to assess their gait.


Please feel free to contact Sprout Health on (02) 9543 4846 if you have any questions or would like to schedule an assessment.


Dated:  29.03.2022

Author: Brooke Giffen

Paediatric Physiotherapist

BPhty | MAPeadPhysPrac (Paediatrics)