pigeon toe foot turned in

[physio.smith]

Is it just one foot that is turned in?

Couple of things spring to mind...
*If only one leg is pronated and internally rotated may be compensatory from leg length discrepancy

*Check out hip quadrant..have found a couple of patients where congenital hip problem was missed and this was causing altered biomechanics

*Make sure neuro is fully assessed...had a couple of missed mild cerebral palsy patients and sharko marie tooth (I know this is spelt wrong)...basically some mild neuro and more serious one can cause similar presentation

*Obviously also check out past history thoroughly...including falls out of trees etc as a child, as had a couple of growth plate type compression injuries that have altered mechanics of knee

[thecrad]

hi again
sorry late getting back, id say could be from early hip problems the foot is turned in on left but with internal tibia rotation not overpronation, dont think its serious the player plays proffessional rugby and doesnt have problems but could obviously optimise his performance more on pitch if corrected and reduce chance of injury
thanks for the input and advice will keep u updated
adrian

[Lachlan]

I think its important to test whether it is a structural problem or a biomechanical problem. If it is biomechanical then it may be possible to alter, although if the patient has no symptoms there should be no reason to in my opinion.

Test for femoral anteversion. Patient in supine, palpate the greater trochanter and internally/externally rotate the femur until the greater trochanter is at its most lateral point. From this position check the alignment of the kneecap- if it is vertical then no excessive anteversion is present (theoretically).

If you have cleared femoral anteversion the next thing to look at is tibial torsion. With the tibial tuberosity facing vertical in supine does the foot internally rotate (excessively)? If so this suggests either tibial torsion or perhaps tightness of the supinators.

If you think its a proximal biomechanical problem have a look for tightness of hip adductors/internal rotators and for weakness / poor control of the external rotators.

If you think its a distal biomechanical problem is it due to tight supinators or weak pronators?