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The Abductory Twist

Date Added: October 18, 2015 06:42:10 AM
Author:
Category: Biomechanics

An abductory twist is often an observation that is seen when doing an observation of the walking and running gait. Just as the rearfoot starts to unweight or raise up off the ground there is a quick sudden abduction or twist seen with the rearfoot. This is a common finding when doing a gait analysis, but its clinical value is of some discussion.

There are a variety of reasons for this abductory twist. The first is that since the rearfoot is pronating (moving inwards at the rearfoot) this is attempting to internally rotate the leg. Simultaneously the other leg is in the swing phase moving forward and is wanting to externally rotate the leg. The lower limb is ‘battling’ with these two opposing motions. Friction between the ground and the heel holds the heel from moving. Whenever force begins to come off the heel, the external rotation force from above can easily abduct the foot and it does so easily. A second reason is that there is a problem at the big toe or hallux joint in which it doesn't allow dorsiflexion adequately. This could be a hallux rigidus, a functional hallux limitus or a issue with the windlass mechanism that affects dorsiflexion at the big toe joint. As that movement is difficult to initiate, the body abducts the heel to go sideways around this joint. Another explanation which is often only found in the physical therapy literature is that the twist is because of control over movement around the hip joint. In that literature it's often termed as a medial heel whip.
The cause of discussion concerning the clinical relevance is that it is just an observation noticed when doing a gait evaluation that is a result of another thing (for example, losing friction with the floor, a problem at the big toe joint or perhaps the hip joint). If it is a concern, then management is aimed at what is creating the abductory twist or medial heel whip rather than aimed at the abductory twist itself. The treatment options to get rid of it is going to be very variable depending on what is the ideal management option for the reason.

There are a variety of reasons for this abductory twist. The first is that since the rearfoot is pronating (moving inwards at the rearfoot) this is attempting to internally rotate the leg. Simultaneously the other leg is in the swing phase moving forward and is wanting to externally rotate the leg. The lower limb is ‘battling’ with these two opposing motions. Friction between the ground and the heel holds the heel from moving. Whenever force begins to come off the heel, the external rotation force from above can easily abduct the foot and it does so easily. A second reason is that there is a problem at the big toe or hallux joint in which it doesn't allow dorsiflexion adequately. This could be a hallux rigidus, a functional hallux limitus or a issue with the windlass mechanism that affects dorsiflexion at the big toe joint. As that movement is difficult to initiate, the body abducts the heel to go sideways around this joint. Another explanation which is often only found in the physical therapy literature is that the twist is because of control over movement around the hip joint. In that literature it's often termed as a medial heel whip.

The cause of discussion concerning the clinical relevance is that it is just an observation noticed when doing a gait evaluation that is a result of another thing (for example, losing friction with the floor, a problem at the big toe joint or perhaps the hip joint). If it is a concern, then management is aimed at what is creating the abductory twist or medial heel whip rather than aimed at the abductory twist itself. The treatment options to get rid of it is going to be very variable depending on what is the ideal management option for the reason.

 

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