Much of what we see in gait analysis is secondary to the anatomical and physiological constraints exhibited by a patient. Take a look at this gentleman running. At first glance, you may be saying “yup, crossover gait, strengthen the gluteus medius complex“.
Now let’s talk about his physical exam. He has “windswept biomechanics“, With external tibial torsion on the right and internal table torsion on the left. There is no significant difference or increase in his Q angles bilaterally. He has a forefoot supinatus on the right side (I.e his forefoot is inverted with respect to his rear foot). He has limited plantar flexion of the first Ray complex on the right.
Now watch the video again with this in mind. Can you understand that if he’s unable to get his first ray to the ground he’s going to have any sort of hike your push off, in order to get it to the Ground he’ll need to mediately rotate his lower extremity and increase the valgus angle on that side. External tibial torsion (when you drop a plum line from the tibial tuberosity, it passes medial to a line passing to the long axis of the second metatarsal) compounds this. Stand up, rotate your right foot to the outside, keep it there and walk forward. Do you see how your knee has to go to the inside to push off your big toe?
Yes, he has a crossover gait but it is obligate and a direct function of his inability to descend the first ray, at least partly due to his forefoot supinatus and his external tibial torsion on the right.
Obligate pathomechanics. Coming to a patient in your office or one of the folks you are coaching soon.
We will be talking about foot types and pathomechanics tonite, October 16th, 2019, on our 3rd Wednesday’s teleseminar on onlinece.com: Biomechanics 314
5 pacific, 6 mountain, 7 central, 8 eastern
Dr Ivo Waerlop, one of The Gait Guys