Thanks Walt, this is great information! I am trying to differentiate forefoot external rotation (abduction) from tibial external rotation because I just took an orthotic seminar that makes a distinction betwwen the two in their algorithm. If the tibia is externally rotated then you have to view the foot external rotation amount by looking in the plane that the tibia is rotated.

Thanks,
Bob D

Hey guys . . interesting post on a critically important topic. Walt, as usual, is in my view right on the money. A few more things to consider; how is it all put back together i.e. misalignments, fascial migration around the pelvis, issues with pubic symph alignment etc. Perhaps looking at tibial torsion is also an issue in some cases of forefoot rotation. Walt's comment on anterior pelvic rotation invites consideration of tight iliopsoas . . anterolisthesis . . kyphosis . . are we on track here Erik D? Following this post with interest, as I am hoping to provide some novel strategies for all of these issues in future workshops in USA. The protocols have been written already. Peace to all. Cheers P

Hi Folks,

Sorry to be so absent. I have been extremely busy in the office, and working on a neck treatment book. It should come out in 2011.

I will throw in a few cents on this topic.

Being a DC, I learned to measure limb length with the patient prone, so I am comfortable with that position. Having said this, I do not put that much importance on limb length, at least not as much as many DCs do. I certainly use it to double check by standing postural evaluation for discrepancies that might cause a low iliac crest height and therefore a compensatory scoliosis, but I do not ascribe the myriad of things to limb length discrepancy that so many DCs do.

I will just throw in a thought about the rotation of the lower extremity, causing the foot to "flare" out. It can come from a number of sources, right? The thigh at the hip joint can be rotated laterally, the knee joint can allow some rotation, at least if the patient's knee joint is flexed. The tibia itself can have torsion in the transverse plane (and usually does), and the tibia can also have a varus bending that alters the position of the foot. And the subtalar (and transverse tarsal) joint can be abducted (I have started calling this lateral rotation because I feel it is more intuitive for students to see), which occurs with pronation. AND, there is the interdependence... e.g., if the hip joint is laterally rotated, then the patient walks over the medial side of the foot, which can cause excessive loss of arch, i,.e, excessive pronation, thus abducting (laterally rotating) the foot...

very complicated...