Normal in new walkers
Babies' hips are often held turned out from their position in the womb, and new walkers turn their feet out for balance. Out-toeing usually improves within the first year of walking.
Posture guide
Duck feet (out-toeing): normal in toddlers, and what matters in adults
Duck feet, or out-toeing, means walking with your feet turned out. In babies and new walkers it's common and usually normal: hips held turned out from the womb, and feet turned out for balance, usually settle within the first year of walking. Children don't need insoles, special shoes or exercises, but a GP should check out-toeing that's on one side, getting worse, or comes with pain or a limp.
In adults, feet that point out mostly reflect how the bones are built: the angle of the thigh bone at the hip, a twist in the shin bone, or flat feet. A little out-toeing is normal, and exercise can't untwist bones, but hip mobility and strength work help you move well with the feet you have.
This guide covers children and adults, what the evidence says about pain, and moves with 3D demos.
The short version
Nothing to correct in children
Insoles, exercises, stretches and special shoes don't correct out-toeing, and children don't need them.
When to see a GP
If it's on one side only, getting worse, causes pain or a limp, the hip seems stiff, or it starts in an older child. An older child or teenager with hip, thigh or knee pain who limps needs to be seen the same day.
Adults: mostly bone shape
In adults, feet that point out mostly reflect the angle of the thigh bone at the hip, a twist in the shin bone, or flat feet. Feet pointing out about 5 to 10 degrees as you walk is normal.
Pain: the evidence is mixed
Some sources link out-toeing bones with hip or knee pain, but the evidence is weak and comes mostly from people having surgery. Exercise can't untwist bones; hip mobility and strength work help you move well with the feet you have.
Out-toeing in babies and children
How children's feet point as they growEmerging evidence
Doctors measure the foot progression angle: how far the feet point in or out as a child walks. Typical values:
- 2 to 3 years: slightly in.
- 5 to 6 years: straight to about 5 degrees out.
- Teenagers: about 5 to 10 degrees out.
Why babies and toddlers turn their feet outStrong evidence
Before walking, many babies hold their hips turned out because of their position in the womb, sometimes with the feet turned out almost sideways. New walkers also turn their feet out for balance. It usually improves within the first year of walking, and in 1,000 normal legs these turns were part of normal development and needed no treatment.
No treatment neededStrong evidence
NHS Lothian's guidance for GPs says insoles, exercises and stretches won't correct out-toeing, and physiotherapy is generally not necessary. American family doctors' guidance says orthotics aren't effective, and recommends explaining to parents that these variations are normal.
In-toeing is the opposite
In-toeing, or pigeon toes, is more common in young children, and also almost always corrects itself without casts, braces, special shoes or surgery. Our in-toeing guide covers it.
Active play
Toddlers need at least 180 minutes of activity a day, and older children and young people an average of at least 60 minutes. No special exercises are needed for out-toeing.
When to see a GP
Babies and children: see a GP if
Most out-toeing is normal. Get it checked if:
- Only one foot turns out, or one side is much worse than the other.
- It's getting worse, or it starts in an older child who didn't have it before.
- Your child has pain or a limp, trips a lot, or struggles to keep up with activities.
- A hip seems stiff, or the legs look like different lengths.
- You've been told there may be a hip problem from birth (hip dysplasia).
- It's still marked after about age 3.
Older children and teenagers
New out-toeing in an older child or teenager, especially with pain in the groin, hip, thigh or knee, can be a slipped growth plate at the hip (a slipped upper femoral epiphysis, or SUFE). Hip problems can be felt in the thigh or knee.
- With a limp: ask for an urgent GP appointment or get help from NHS 111 the same day, and don't let them walk, run or play sport on it while you wait.
- If they suddenly can't walk or put any weight on the leg, or the leg is turned outwards and looks shorter: go to A&E.
- Weeks of groin, thigh or knee pain that comes and goes, or walking or running with a foot turned out even without a limp: ask the GP to examine the hip, and say you're worried about a slipped growth plate.
Adults: see a GP or physiotherapist if
Get it checked if:
- Out-toeing is new or on one side only, or comes with a limp or hip or groin pain.
- Pain at the front of the knee doesn't settle with exercise.
- A flat foot is painful, stiff, weak or numb, has changed shape or is only on one side, or you keep injuring your feet or ankles.
Adults: get help straight away
Call 999 or go to A&E for severe hip pain after a fall or injury, if you can't walk or put weight on the leg, or for tingling or loss of feeling in the hip or leg after an injury.
Source 14
Why adults' feet turn out
A little out-toeing is normalEmerging evidence
Teenagers' and adults' feet usually point out about 5 to 10 degrees as they walk; healthy older adults in one study averaged about 10 degrees.
The thigh bone
The neck of the thigh bone is normally twisted forward (anteversion) by about 40 degrees at birth, falling to about 15 degrees in adults. When it's twisted less, or backwards (femoral retroversion), the hip turns out further and in less, and the feet tend to point out.
The shin bone
The shin bone is twisted inward in infancy and normally turns outward by about age 5. An extra outward twist (external tibial torsion) usually shows at 4 to 7, often in both legs, and can increase with growth.
Flat feet
Flat feet are common and usually cause no problems; arches develop between 3 and 10. Flat feet can add to out-toeing. Insoles and exercises don't change the shape of the feet, but they can help pain or stiffness.
Does it matter for pain? What the evidence says
We found no trial of exercise for out-toeing itself. Surgery to untwist a bone is rare and only for selected people with pain.
Out-toeing bones and the hipMixed evidence
A 2017 American Family Physician review lists osteoarthritis and stress fractures as results of femoral retroversion, citing a single reference. A 2025 systematic review of 11 studies (1,807 patients and 785 cadavers; we read its summary) found some link with hip pain and impingement, and retroversion in 5 to 11% of people having hip replacements, but said evidence that it causes hip arthritis is lacking, and found contradictory results for surgery.
Out-toeing bones and the kneeMixed evidence
An extra outward twist of the shin bone is a recognised cause of pain at the front of the knee: when the foot points forward, the knee points inward. This comes from selected groups of patients having surgery; in 73 women with front-of-knee pain that hadn't settled with treatment, twisted thigh or shin bones were very common. There's no agreed threshold for when a twist matters.
Knee arthritis and toe angleEmerging evidence
People with arthritis of the inner knee walked with slightly less toe-out than people without (6.7 against 10.3 degrees). In a trial in 68 people with this arthritis, a personalised change of toe angle, taught in a gait lab, reduced pain by about 1.2 points out of 10 at a year. That's a specialist treatment, not a self-help tip.
Running
We found no study showing that out-toeing causes running injuries, or that changing your natural foot angle prevents them.
Dancers' turnoutMixed evidence
A review of 7 studies (1,293 dancers) couldn't draw firm conclusions about forcing turnout and injury. A 2026 review of 4 studies (431 ballet dancers) found 3 that linked forced (compensated) turnout with injury, and suggested keeping it within about 25 degrees, on limited evidence.
Hip mobilityEmerging evidence
In 28 young adults whose hips turned in very little, two 1-minute bouts of slow hip circles (controlled articular rotations, or CARs) raised inward rotation from 28.6 to 33.6 degrees, and static stretches from 26.4 to 33.2 degrees, still raised 15 minutes later. Longer-term effects weren't tested, and this changes hip range, not the shape of the bones.
Source 20
What helps
Don't force your feet straight
If your shin bone is twisted outward, pointing your foot straight ahead turns your knee inward. In squats and lunges, let your feet turn out to where your knees track over your middle toes (our editorial advice, matching the knock knees guide).
Source 9
Hip mobility, if your hips turn in very little
Hip circles and stretches such as the figure four both added range in the short term. The trial used two 1-minute bouts of circles with a 20-second rest, or 4 holds of 30 seconds for each stretch, with 10 seconds' rest between holds.
Source 20
Feet that ache
If flat feet ache, insoles, supportive shoes, stretches and foot exercises can ease pain or stiffness; they won't change the shape of the feet. The flat feet guide has a plan.
Source 7
Children
Active play, and a GP visit if any of the warning signs appear. There's nothing to correct.
Find your squat stance
Our editorial advice, using the knock knees guide's cue of knees over the middle toes.
- Stand with your feet about hip-width apart and let them turn out to wherever feels natural.
- Squat a little way down and look at your knees: they should point over your middle toes.
- If your knees point inside your feet, turn your feet out a little more or widen your stance; if they point outside, turn them in a little.
- Keep that stance and squat as deep as is comfortable, then stand up.
- Do 2 to 3 sets of 10. There's no single correct foot angle: the right one is where your knees and feet line up.
See the movement on the 3D figure: Bodyweight squat
Hip rotation
For hips that turn in very little: these change range, not foot angle. Hip CARs: 3 slow circles each way with each leg, 20 to 30 seconds a circle (the move page's dose; the trial used two 1-minute bouts). Figure four: 4 holds of 30 seconds each side, as in the trial. 90/90 switches: 10 slow switches; windshield wipers: 10 slow passes side to side, 2 rounds; hip airplanes: 2 sets of 5 slow turns each leg (the move pages' doses).
Feet and ankles
For feet and ankles that ache. Towel curls, 2 to 3 sets of 10; band inversion, 3 sets of 10 to 15; slow calf raises, 2 to 3 sets of 12 to 15; tibialis raises, 2 sets of 15 to 20; one-leg stands, 3 holds of 20 to 30 seconds (editorial starting points).
Strength with your knees over your toes
Let your feet turn out to where your knees track over your middle toes. Squats, 2 to 3 sets of 10; goblet squats, 3 sets of 8 to 10; step-ups, 3 sets of 8 each leg; bridges, 2 to 3 sets of 10 to 15 (editorial starting points).
Workouts to follow
The hip mobility routine and the foot and ankle routine cover the range and foot work; the knee control warm-up practises knees over toes. The animal moves workout is for children's play, not a treatment.
Hip mobility routine
A 15-minute hip opener: 90/90 switches, windshield wipers, CARs, Cossack squats, frog and pigeon.
15 minIntermediate8 movesA wall
Yoga for tight hips
A hip-opening yoga sequence: low lunge, lizard, goddess, pigeon, bound angle and happy baby.
20 minBeginner7 movesNo equipment
Foot and ankle strengthening routine: toes, arches, calves and balance
A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructions
Balance exercises routine
Balance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or box
Knee control warm-up
A 20-minute warm-up that trains your knees to track over your toes: side-hip strength, squats and lunges with alignment practice, balance and quiet landings.
20 minBeginner10 movesA wall, A band
Animal moves for kids: a 15-minute active play workout
Fifteen minutes of animal moves, jumps and balance games for children, building the muscle- and bone-strengthening activity they need, with nothing to buy.
15 minBeginner16 movesA wallMyths
"Toddlers with duck feet need insoles, special shoes or exercises."Strong evidence
NHS Lothian: "Insoles and exercises will not correct this, neither will stretches." Orthotics aren't effective for out-toeing.
"Duck feet always need insoles."Strong evidence
Insoles don't change foot angle or foot shape. They can help painful flat feet, and painless flat feet don't need them.
"Stretches can fix duck feet in adults."Emerging evidence
Adult out-toeing mostly comes from the shape of the bones. Stretches and hip circles add some hip range in the short term, but they don't untwist bones.
"Duck feet cause knee and ankle injuries."Mixed evidence
We found no study showing that out-toeing itself causes injuries. An extra outward twist of the shin bone is one cause of front-of-knee pain, in selected patients having surgery.
"Sitting too much or anterior pelvic tilt causes duck feet."
We found no evidence for this. The known causes are the shape of the bones, flat feet and, in young children, normal development.
"Point your feet straight when you walk, run or squat."Emerging evidence
With an outward-twisted shin bone, pointing the foot forward turns the knee inward. Let your knees and feet line up.
Source 9
Read next
Questions people ask
Is it normal for toddlers to walk with their feet turned out?
Yes. Babies' hips are often held turned out from their position in the womb, and new walkers turn their feet out for balance. It usually improves within the first year of walking.
When should I worry about my child's out-toeing?
See a GP if it's on one side only, getting worse, causes pain or a limp, the hip seems stiff, or it starts in an older child. An older child or teenager with hip, thigh or knee pain who is limping needs to be seen the same day.
Do children with duck feet need insoles, special shoes or exercises?
No. NHS specialists say insoles, exercises and stretches won't correct out-toeing, and physiotherapy generally isn't needed.
Why do my feet point out as an adult?
Usually because of how your bones are built: the angle of the thigh bone at the hip, a twist in the shin bone, or flat feet. Feet that point out about 5 to 10 degrees as you walk are normal.
Is being duck-footed bad for you?
Usually not. We found no study showing that it causes running injuries, and the links with hip and knee pain come mostly from people having surgery. A large twist in the shin bone is one cause of pain at the front of the knee.
How do you fix duck feet?
Exercise can't untwist bones, and adults don't need to point their feet straight. Hip mobility work can add some inward hip rotation, and strength work helps comfort and function.
Should I force my feet to point straight when I walk?
No. If your shin bone is twisted outward, pointing your foot straight turns your knee inward. Let your feet turn out to where your knees track over your toes.
Can duck feet cause knee pain?
Out-toeing on its own isn't a known cause. A large outward twist of the shin bone is a recognised cause of pain at the front of the knee, and people with knee arthritis actually walked with slightly less toe-out than people without.
Should runners with duck feet change their stride?
We found no evidence that changing your natural foot angle prevents running injuries. In knee arthritis, a personalised change of toe angle taught in a gait lab reduced pain, but that's a specialist treatment.
What's the difference between duck feet and pigeon toes?
Duck feet point out; pigeon toes (in-toeing) point in. In-toeing is more common in young children and has its own guide.
My teenager walks with one foot turned out and has knee pain: is that serious?
It can be a slipped growth plate at the hip, so get it checked. With a limp, ask for an urgent GP appointment or get help from NHS 111 the same day; if they suddenly can't put weight on the leg, go to A&E.
Sources
- Staheli 1985 · Leg rotation in children: normal values from 1,000 limbs (measurement study, J Bone Joint Surg Am)
- Rerucha 2017 · Lower extremity abnormalities in children (review, American Family Physician)
- NHS Lothian · Out-toeing (children's orthopaedic guidance for GPs, RefHelp, 2024)
- NHS Lothian · Normal lower limb variants in childhood (Royal Hospital for Children and Young People leaflet; its September 2026 review date has passed)
- Vlaic 2026 · Leg alignment variations in children: practical guidance for paediatricians (review, Medicina)
- NHS · Limping in children
- NHS · Flat feet
- Tsagkaris 2025 · Femoral retroversion, out-toeing and hip osteoarthritis (systematic review, Acta Orthop)
- Sanchis-Alfonso 2026 · Front-of-knee pain and an outward-twisted shin bone in women: rotational osteotomy (review, J Clin Med)
- Baird 2025 · Lower extremity abnormalities in children (review, American Family Physician; summary and key recommendations read)
- British Society for Children's Orthopaedic Surgery · Intoeing (patient leaflet, January 2024; its January 2026 review date has passed)
- NHS · Physical activity guidelines for children under 5
- NHS · Physical activity guidelines for children and young people
- NHS · Hip pain in adults
- Bechard 2012 · Toe-out, trunk lean and pelvic tilt while walking in knee osteoarthritis (comparison study, Arthritis Care Res)
- Sanchis-Alfonso 2025 · Twisted thigh and shin bones in women with stubborn front-of-knee pain (CT study, J Exp Orthop)
- Uhlrich 2025 · Personalised gait retraining (changing the toe angle) for knee osteoarthritis (RCT, Lancet Rheumatol)
- Kaufmann 2021 · Forced or compensated turnout and injuries in dancers (systematic review, J Biomech)
- Ota 2026 · Compensated turnout and leg injuries in ballet dancers (systematic review, J Bodyw Mov Ther)
- Head 2026 · Hip CARs (controlled articular rotations) versus static stretching for inward hip rotation (RCT, Int J Exerc Sci)
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Get a curve or hunch that is new or getting worse checked, above all in a growing child or after a fall, and get urgent help for numbness or weakness in the legs or a change in bladder or bowel control. Health disclaimer.