pigeon toe foot turned in

[thecrad]

hi all
just a question regarding an athlete with foot turned in we are doing biomechanics assessment on a rugby team and player walks/runs with foot turned in could a tight piriformis be causing this or more likely to be below knee structures that are tight
any advice appreciated
adrian

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[Canuck Physio]

Hmm...

Nice idea to think that the problem may be associated from an area that is not the problem either 'visually' or 'observable'.

I like this story:
There is an old Sufi story about philosopher-fool Nasrudin, who was looking for his house keys under a street light. A couple of friends happened by and joined in the search. Finally, in exasperation, one of the friends asked Nasrudin where he thought he had lost the keys. Nasrudin pointed to a spot some distance away where it was extremely dark. But why are we looking here then? he was asked. He replied: Because it is so much easier to see under the light.

I don't quite see the connection between a tight piriformis and an inverted or medially rotated foot. If the Piriformis is tight place the patient supine and elevated upper body. 'Tight' hip external rotators should result in external rotation of the leg which should result in lateral rotation of the foot as opposed to internal or medial rotation.

Unless I am missing something?

Regards

[thecrad]

thanks for reply
this is what i thought but im on placement and physio says its due to pirifromis working as an internal hip rotator past 90 i would have thought it would be more lower limb below knee in this case? ankle or soft tissue
adrian

[hari priya]

Hmm...

Nice idea to think that the problem may be associated from an area that is not the problem either 'visually' or 'observable'.

I like this story:
There is an old Sufi story about philosopher-fool Nasrudin, who was looking for his house keys under a street light. A couple of friends happened by and joined in the search. Finally, in exasperation, one of the friends asked Nasrudin where he thought he had lost the keys. Nasrudin pointed to a spot some distance away where it was extremely dark. But why are we looking here then? he was asked. He replied: Because it is so much easier to see under the light.

I don't quite see the connection between a tight piriformis and an inverted or medially rotated foot. If the Piriformis is tight place the patient supine and elevated upper body. 'Tight' hip external rotators should result in external rotation of the leg which should result in lateral rotation of the foot as opposed to internal or medial rotation.

Unless I am missing something?

Regards

i agree with you that the piriformis could not be the cause for pronated foot in the athelte.can you specify other biomechanical factors resulting in pronated foot in this player.

[Canuck Physio]

thanks for reply
this is what i thought but im on placement and physio says its due to pirifromis working as an internal hip rotator past 90 i would have thought it would be more lower limb below knee in this case? ankle or soft tissue
adrian

If the individuals foot were internally rotating while he was sitting, then this may be a possible explanation because the piriformis does act as a slight internal rotator in this position.

However, if the individual is in standing this is an entirely different case.

[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?