Two things we hope you see right away when viewing this video.

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We talked about this woman in yesterday‘s post and, when viewing from the front, we wanted to bring out a few salient points

Notice how her foot progression angle is diminished bilaterally. Normally the foot will “toe out“ somewhere between 12 and 20° when the foot hits the ground and hers are nearly straightahead. This can be due to numerous things such as femoral retro torsion, internal tibial torsion, or subtalar version. All of these things will often have the foot point medially when examining a patient on the table and placing the knee in the sagittal plane. In this particular case, she has internal tibial torsion.

The next thing we would like you to look at is noting how her knee falls “outside“ the sagittal plane. In other words, instead of the knees pointing straight ahead, the point slightly out laterally. This is a cardinal sign of internal tibial torsion, especially in a gait analysis.

So what’s a clinician to do?

In this particular case, there’s nothing really to “fix“ as these are hard deformities that are often congenital. Our job is to help the patient to compensate and the best way possible so that they can remain pain and as injury free as possible. We discussed remediation in the post yesterday, So please refer back to that for what we did


Dr Ivo Waerlop, one of The Gait Guys

#invertedforefoot #forefootsupinatus #forefootvarus #pronation #forefoot #gaitanalysis #decreasedprogressionangle #toeingin

Sometimes it’s OK for “toes in“ squats

We hear from folks and also read on a lot of blogs and articles about whether your toes should be in or out for squats or other types of activities. The real answer is “it depends”.

What it depends on is the patient’s specific anatomy. That means we need to pay attention to knees and hips and things like femoral and tibial torsion‘s. It’s paramount to keep the knees in the sagittal plane, no matter what the lower extremity orientation is.

When somebody has external tibial torsion (i.e. when you drop a plumbline from there to view tuberosity it passes medial to the line between the second and third or second metatarsal) then having your feet and externally rotated position places the knees in sagittal plane. Having the patient go “toes in” with this type of anatomy will cause both knees to for medially and create patellofemoral tracking issues.

Likewise, like the patient in the video, (Yes, I know I say “external tibial torsion“ at the beginning of the video but the patient has internal tibial torsion as you will see from the remainder of the video) when somebody has internal tibial torsion (I.e. when you drop a plumbline from the tibial tuberosity it passes lateral to the second metatarsal or a line between the second and third metatarsal) you would need to point the toes inward to keep the knees in the sagittal plane as demonstrated in the video. You can also see in the video when her feet are placed “toes out“ they fall outside sagittal plane laterally which creates patellofemoral tracking issues like it was in this particular patient.

So, knees in or knees out? It depends…

Dr. Ivo Waerlop, one of The Gait Guys

#internaltibialtorsion #externaltibialtorsion #kneepain #kneesin #kneesout #squats #thegaitguys