- Clinical history
- Commonly seen in early walkers due to restricted internal rotation of the hip.
- May be associated with knock knees (genu valgum) and flatfoot.
- Be aware of serious causes such as slipped upper femoral epiphysis.
- Physical examination
- Observe the child’s gait.
- Place in prone and check for internal and external hip range of motion, thigh-foot angle, and foot posture.
- GP management
- Reassure the parents that the majority of out-toeing will resolve as the child grows and that no treatment is required.
- Exclude other causes such as slipped upper femoral epiphysis.
- Indications for specialist referral
- if progressive out-toeing
- functional difficulties
- asymmetrical deformity
- thigh-foot angle exceeds 30 to 40 degrees
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