So, What’s going on here?

Remember torsions and versions? If not, click here, here, here and here for a review. 

In the top left view, you are seeing the left foot in a neutral posture with the knee in the (relative) midline. Notice how the foot adducts? This person has INTERNAL TIBIAL TORSION. They also have hammer toes and a cavus (high) arch. 

In the top right, the foot is again in a neutral posture and the R foot is adducted EVEN FARTHER. Again, internal tibial torsion along with hammer toes and a cavus foot. For a hint, look at the tibial tuberosity; it should line up with an imaginary line drawn through the 2nd metatarsal. 

In the middle left picture I am fully internally rotating the R leg. Hmm, no internal rotation of the hip (note the knee goes little beyond midline). You need 4 degrees of internal rotation of the hip to walk normally and most folks have 40 degrees. This person has FEMORAL RETROTORSION.

In the middle right picture I am fully internally rotating the L leg. Hmm, no internal rotation of the hip here either; in fact, even less than the right. Again, FEMORAL RETROTORSION. 

In the bottom two pictures, the goniometer is aligned with the ASIS and tibial tuberosity. I am not sure if you can see it, but it is 18 degrees on the left and 20 on the right. Normally the Q angle is between 8 and 12 degrees. This person has developed compensatory GENU VALGUS.

Does it surprise you he has pain on the outside of his feet? How about knee pain?

So what does this mean?

  • he will have a decreased progression angle of the feet
  • he will externally rotate the feet to allow a more normal progression angle and “create” the internal rotation of the hip needed
  • this will place the knee out side the saggital plane and create a potential conflict at the knee
  • he will stress the ligaments at the medial knee secondary to his valgus deformity
  • he will increase the pressure on the lateral condles of the femur and lateral tibial plateau, leading to early degeneration

So what do you do?

  • normalize, to the best of his (and your) abilities, foot and lower extremity mechanics with manipulation, exercise, etc
  • ensure he has an adequate foot tripod with the tripod and EHB exercises
  • In his case, construct an orthotic, which will correct rearfoot pronation and yet not push the knee outside the saggital plane, by having a forefoot valgus post in place
  • educate him about proper footwear with an adequate toe box and not too much torsional rigidity (ie no motion control features)
  • follow him at regular intervals to make sure he doesn’t fall off the turnip truck
The Gait Guys. Making it real, every day, every post, every PODcast.
all material copyright 2013 The Gait Guys/ The Homunculus Group.

A Mystery: Why Can’t We Walk Straight? : NPR

We cover this topic, and so much more, in our own way on Podcast #31 on The Gait Guys Experience Podcast (link here).

Still haven’t joined us on a podcast yet ? You might be shocked at how much you learn about gait, the human body and so much more. We start each podcast with a neuroscience piece talking about the latest breakthroughs in science that will be coming our way to help us function as humans.

Give us a listen, what do you have to lose ? Take Dr. Ivo and Dr. Shawn on your next car ride, on your next trip to cut the lawn, your next walk or run.  Let our bad jokes and strange ways entertain you !

Here was some of the research that led to our podcast discussion.

Curr Biol. 2009 Sep 29;19(18):1538-42. doi: 10.1016/j.cub.2009.07.053. Epub 2009 Aug 20.

Walking straight into circles.


Multisensory Perception and Action Group, Max Planck Institute for Biological Cybernetics, Spemannstrasse 41, 72076 Tübingen, Germany.


Common belief has it that people who get lost in unfamiliar terrain often end up walking in circles. Although uncorroborated by empirical data, this belief has widely permeated popular culture. Here, we tested the ability of humans to walk on a straight course through unfamiliar terrain in two different environments: a large forest area and the Sahara desert. Walking trajectories of several hours were captured via global positioning system, showing that participants repeatedly walked in circles when they could not see the sun. Conversely, when the sun was visible, participants sometimes veered from a straight course but did not walk in circles. We tested various explanations for this walking behavior by assessing the ability of people to maintain a fixed course while blindfolded. Under these conditions, participants walked in often surprisingly small circles (diameter < 20 m), though rarely in a systematic direction. These results rule out a general explanation in terms of biomechanical asymmetries or other general biases [1-6]. Instead, they suggest that veering from a straight course is the result of accumulating noise in the sensorimotor system, which, without an external directional reference to recalibrate the subjective straight ahead, may cause people to walk in circles.

A Mystery: Why Can’t We Walk Straight? : NPR

Podcast #31: Walking Straight, Mastalgia & Shoes

podcast link:

iTunes link:

Gait Guys online /download store:

other web based Gait Guys lectures:   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

1. Neuroscience Piece:

Today we have a neuroscience piece on “turning”, in a matter of speaking. So why, when blindfolded, can’t we walk straight?

These “Turning” field studies appear in Chris McManus’ book, Right Hand, Left Hand, The Origins of Asymmetry in Brains, Bodies, Atoms and Cultures (Phoenix, 2002). 

NPR Story Produced by Jessica Goldstein, Maggie Starbard.

2. neuroscience 2 at the end of the show.

The myth of the 8 hour sleep
3. Blog reader asks:
Any shoe recommendations for an uncompensated forefoot varus?

4. and another from the Blog:
Hi The Gait Guys, what can I do to regain medial tripod? I have a forefoot varus and when I am standing it compensates and my rearfoot everts and gets valgus. I have been having some pain lately and it is annoying me a lot. Please help. Thank you.
5. FACEBOOK readers asks:

Bringing the Foot Back To Life: Restoring the Extensor Hallucis Brevis Muscle.


Foot loading patterns can be changed by deliberately walking with in-toeing or out-toeing gait modifications.

Gait Posture. 2013 Apr 25. pii: S0966-6362(13)00190-2.

7. The Gait Guys are always talking about ankle rocker, dorsiflexion strength and the importance of the anterior compartment of the lower leg. Here is another study to add fuel to our fire.

Ankle dorsiflexor strength relates to the ability to restore balance during a backward support surface translation

Gait & Posture


8. Shoes:

NB new Minimus 10V2

The Minimus 10 is back – and better than ever. The MR10v2 is the latest version of the previous Minimus Road 10,


Study: One-Third of Female Marathoners Report Breast Pain

10. Painkiller meds taken before marathons

from the British Medical Journal

11. The myth of the 8 hour sleep
By Stephanie Hegarty BBC World Service

Dr. Jacquelin Perry, the guru of gait has left our world for a better place.

Here is an article on one of the, if not the, grandparent of gait studies from which many of us started our journey into gait. We just learned that on March 11, 2013 Dr. Jacquelin Perry passed away in her home at age 94.

Thank  you for all you gave us Dr. Perry.  RIP.

Thanks for all your inspiration and guidance. May you find yourself in a better place where everyone’s gait is pristine and perfect, so you may rest your mind at last.

blog link:

Shawn and Ivo, The Gait Guys … . .  mere infants of gait in her enormous shadow.