Gait—the manner in which a person walks—is a complex biomechanical process involving coordinated movements of the muscles, bones, and joints. Subtle deviations in gait can reveal underlying musculoskeletal or neurological issues. One such deviation is the abductory twist, a phenomenon observed during the stance phase of walking. Though often overlooked, an abductory twist can be a key indicator of biomechanical dysfunction in the lower limb, particularly involving the foot and ankle.

Understanding Gait Mechanics

To appreciate what an abductory twist is, it’s important to understand the basic phases of gait:

1. Heel Strike: The heel contacts the ground.
2. Foot Flat: The entire foot makes contact as weight is transferred.
3. Midstance: The body passes over the stationary foot.
4. Heel Off: The heel lifts off the ground.
5. Toe Off: The toes push off to propel the body forward.

During these phases, the foot undergoes pronation (rolling inward) and supination (rolling outward) to absorb shock and adapt to the terrain. Ideally, the foot should transition smoothly from pronation to supination as it prepares for toe-off. However, when this transition is disrupted, compensatory movements may occur—one of which is the abductory twist.

What Is an Abductory Twist?

An abductory twist refers to a sudden outward movement (abduction) of the heel or foot during the toe-off phase of gait. It is typically observed as a quick lateral flick of the heel just before the foot leaves the ground. This motion is not part of normal gait mechanics and usually indicates that the foot is compensating for instability or misalignment elsewhere in the kinetic chain.

The twist is most noticeable when viewed from behind and is often seen in individuals with excessive pronation or poor foot control. It may also be accompanied by other signs of gait dysfunction, such as medial knee collapse or hip rotation.

Biomechanical Causes of Abductory Twist

Several biomechanical factors can contribute to the development of an abductory twist:

1. Excessive Pronation

When the foot rolls inward too much during midstance, it delays the transition to supination. As the body attempts to push off, the foot may twist outward to compensate for the lack of rigidity needed for propulsion.

2. Forefoot Varus

This structural deformity causes the front of the foot to tilt inward. To achieve ground contact during gait, the foot may overpronate, leading to an abductory twist during toe-off.

3. Weakness in Tibialis Posterior

The tibialis posterior muscle helps control pronation and stabilize the arch. Weakness or dysfunction in this muscle can result in poor foot control and compensatory twisting.

4. Hip and Pelvic Instability

Instability or weakness in the hips and pelvis can affect lower limb alignment. If the leg rotates inward excessively, the foot may twist outward during toe-off to maintain balance.

5. Tight Calf Muscles

Limited ankle dorsiflexion due to tight calves can alter gait mechanics, forcing the foot to twist outward to clear the ground.

Clinical Significance

An abductory twist is more than just a visual anomaly—it can be a sign of underlying pathology. Clinicians, especially podiatrists and physical therapists, use gait analysis to identify such compensations and determine their root causes. Left unaddressed, an abductory twist can lead to:

• Plantar fasciitis
• Achilles tendinopathy
• Medial knee pain
• Hip and lower back discomfort
• Increased risk of injury during sports or exercise

Recognizing and correcting the twist can improve gait efficiency, reduce pain, and prevent further complications.

Diagnosis and Assessment

Diagnosis typically involves:

• Visual Gait Analysis: Observing the patient walking barefoot from behind.
• Video Gait Analysis: Using slow-motion footage to detect subtle movements.
• Footwear Examination: Uneven wear patterns on shoes may indicate abnormal gait.
• Biomechanical Testing: Assessing foot structure, muscle strength, and joint mobility.

Treatment and Management

Treatment focuses on addressing the underlying cause of the abductory twist. Common interventions include:

1. Orthotics

Custom foot orthotics can correct structural imbalances, support the arch, and control excessive pronation.

2. Strengthening Exercises

Targeted exercises for the tibialis posterior, gluteal muscles, and core can improve stability and alignment.

3. Stretching

Stretching tight calf muscles and hip flexors can enhance mobility and reduce compensatory movements.

4. Footwear Modification

Supportive shoes with proper arch support and heel control can help manage gait abnormalities.

5. Manual Therapy

Physical therapists may use techniques to mobilize joints and release tight tissues contributing to poor gait mechanics.

Conclusion

An abductory twist during gait is a subtle yet significant indicator of biomechanical dysfunction in the lower limb. While it may seem minor, it often reflects deeper issues such as overpronation, muscle weakness, or structural deformities. Early recognition and targeted intervention can restore proper gait mechanics, alleviate pain, and prevent long-term complications. By understanding and addressing the abductory twist, clinicians and patients alike take a crucial step toward healthier movement and improved quality of life.

Chilblains are a reasonably common problem once the weather is cooler. These are a painful and itchy reaction of the smaller blood vessels in the toes to the variations in temperature. They result in a painful red area, which later becomes a dark blue color should they become chronic. Chilblains have just lately been receiving some extra press in the media as a result of them being more common in those infected with the coronovirus, being given the term, COVID toes.

Chilblains are a seasonal condition and appear in all places in which the climate gets cold enough to result in the reaction in the skin. An instance of PodChatLive had a deep discussion of the problem of chilblains:

The easiest method to manage chilblains is usually to prevent these by keeping the feet warm. If a chilblain will develop then it must be kept warm and be protected to stop the skin from breaking down. There are several chilblain creams which you can use to help to promote the blood circulation.

Severs disease or calcaneal apophysitis is a prevalent condition of the heel bone in developing children. At the back of the heel bone is a cartilage area that most of the development of the heel bone takes place at and this problem is an overuse injury of that cartilage area. It is more likely in kids that are active, are overweight and are taller. The typical signs of Severs disease is pain at the back and sides of the heel bone, primarily after sports activity. Severs disease is regarded as a self limiting problem, because the child will invariably at some point grow out of it as soon as growth of the heel pain stops and the developing region of cartilage inside the bone merges with the rest of the heel bone. That doesn’t suggest it shouldn’t be treated and may not be treated before that growth ceases.

This episode from PodChatLive was a comprehensive discussion into the issue of Sever’s disease/Calcaneal apophysitis:

A great way to take care of this problem can be managing the child’s and parent’s expectations and also lifestyle to help keep the signs and symptoms under control. The strains have to be managed via modifying and restricting activity levels. This is often challenging and may take some negotiation with the child. If the discomfort is severe after activity, then ice may be used to help relieve that. Often a cushioned heel insert might help protect the heel. Long term the prospects is good as they will grow out of this by the mid-teenage years.

Type two diabetes has become so common, it is almost as though we have become complacent regarding it. The incidence is rising in most places despite public health strategies are attempting to take care of the obesity crisis that is supporting the diabetes challenge. Diabetes has a number of complications that all combine collectively to put the feet at significant risk from complications. These complications vary from a mild infection to the more critical complications like a need to amputate a leg a result of a spreading infection or deceased tissue. The complications associated with diabetes have an effect on a wide variety of tissues in the body.

In relation to the feet, diabetes affects the blood supply and therefore any injury to the foot is more likely to be serious as there is insufficient good blood flow allowing healing to occur. Diabetes also damages the nerves, so that if there is some injury, either major or minor such as a blister, then no pain is felt, so the foot continues to be damaged resulting in the complication a great deal more severe. The body has numerous functions to fight infection, but in diabetes the response to an infection is much more sluggish than in those without diabetes. Diabetes can also affect the eye and while the eyes are a long way from the foot, ample vision is needed to see any issues that may have occurred to the foot so it may be dealt with. Even the renal disease that frequently occurs in diabetes impacts wound healing after the injury has been done and the presence of disease in the kidney can affect what medicines, for example antibiotics, may be used and sometimes that range can be quite restricted.

It is for all these complications, and others not brought up, that those with diabetes have to take additional care of their feet. They need to check them routinely to make sure that there is no injury and if there is an injury they must get medical help quickly. Most importantly, they must be regularly managed by a foot doctor.

There is a old process from rural China that involved the binding of the foot of female young people to stop them from growing. It was a barbaric practice and was painful and disabling to the feet. It was done as a small foot was thought to be an attractive characteristic in the female and a greater dowry can be demanded by the family for the bride-to-be if the feet had been bound. There was a substantial market in these rural communities for the ornamental and finely crafted shoes that these people would need to wear because of the smaller and misshaped feet. Around 100 or so years ago societal pressures did start to mount to ban the practice and this largely was successful and it is not carried out nowadays. The practice needed to stop as it was so debilitating and painful for the girls. When they became a grownup, the harm had been done and there was very little that might be done to deal with the pain and disability. Having said that, you can still find many older woman alive that had their feet bound when they were young children.

There are apparently commonalities to this practice of chinese foot binding that could be seen these days. Several commentators like to link the practice these days of females who push their feet inside the high heel footwear as being the same as the practice. In rural China the technique was all about the female performing something which pleases the male, no matter the outcomes in terms of discomfort and deformity. The practice today of using tight fitting high heel shoes by females has outcomes in the terms of foot deformity and foot problems. It is also apparently done in the perspective of the female doing something which is agreeable to the eye of the male. There is some argument if the connection between the two practices really do justify the kind of exploration that they have been subjected to.