The Solitary Turned out Right foot in a Barefoot Runner: Part 2

Here is a perfect example why we sometimes cringe when someone comes into our office with pain or problems and wearing minimalist shoes or worse yet, claims to be a barefoot runner.  This is a perfect example of a client, whether they are in your shoe store or in a medical office, that needs to be convinced to remain in their more stable trainers until the problem is unwound. 

In this video it is plain for anyone to see that the right foot/lower limb is clearly externally rotated and pronating excessively when compared to the left side.  This could be from weakness of the gluteus medius, loss of internal rotation or one of several other biomechanical flaws (be sure to review Dec 15th blog post on these topics ). However, it could also be anatomic.  This could be from external tibial torsion or a torsion at the femur.  Regardless, it is likely creating a functional short leg on the right because when we pronate heavily like this, the height of the talus and arch drops further than normal, and in this case further than the other side.  However, one could argue the opposite, meaning that this person is pronating heavily on the right to shorten that leg to be equal to an already shorter left leg. In order to know, and not guess, you have to assess your client.  As indicated above, the internal limb spinning pronation could be a compensation to gain more entire limb internal rotation from a loss of hip rotation. Yes, there could be many causes. In this latter case, prescribing an orthotic to dampen this pronatory excess would be a mistake for the hip even though it would be a logical intervention at the foot level.  Our direction would be to find the cause of the right limb turn out and hyperpronation.  Video gait analysis and guessing will not get you there.  You have to assess your clients neuromuscular ability and deficits.  If one were to bet on impaired internal hip rotation, a fairly high probability bet, then how many internal rotators of the lower limb can you name immediately without looking them up ? You will need this info at the tips of your fingers in an exam if you are going to prove or disprove the internal hip rotation theory.  Here are a few to get you started:

• vastus lateralis
• TFL-ITB
• anterior head of gluteus medius
• reflected head of rectus femoris
• adductor brevis
• coccygeal division of gluteus maximus
• how many others can you name and accurately test so that you are not guessing when it comes time to assess your client ?

Welcome to the complex game we play every day with our athletes and “every day Joe’s”. It is a brain knocking game, and  you have to juggle many factors while sorting it out. ! Tomorrow we will talk a little about possible problems of Functional Screens and how they can be used to help assess, but also how they can fool you.

Have a good Monday gang….. and watch for the rampant spreading plague of the turned out foot.  It is nationwide already !

Shawn and Ivo, The Gait Guys