Watch this video a few times through and see what you notice. There are three clues that this patient has internal tibial torsion, can you find them?
He presented with right sided knee pain, medial aspect of the patella and medial joint line as well as tenderness over the medial joint line and pes anserine. Lower extremity musculature test strong and 5/5 save for his semi tendinosis on the right which tested 4/5.He has diminished endurance bilaterally in the external obliques
1. Note how his knees, right greater than left, fall outside the sagittal plane
2. Note the decreased progression angle of both feet during forward motion
3. Note how he toes off in supination, right greater than left.
This patient’s knee pain is coming from irritation of the pes anserine, particularly semitendinosus and his inability to recruit his abdominals sufficiently so, instead of the usual pattern of recruiting iliopsoas or rectus femoris, he chooses his sartorius, gracious and semi tendinosis.
Pay attention to how the new tracks, the progression angle as well as if they tow off in pronation, neutral, or supination in that can offer subtle clues to internal tibial torsion.
Dr Ivo Waerlop, one of The Gait Guys