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The Abductory Twist

Discussion in 'Articles' started by Admin, Oct 18, 2015.

  1. Admin

    Admin Administrator Staff Member

    The abductory twist is often an observation which is found during an observation of the gait. As soon as the heel starts to off-load or raise up the ground there's a fast sudden abduction or twist noticed of the heel. It is a commonplace observation during a gait evaluation, but its clinical value is actually of some argument.

    There are a number of explanations for this abductory twist. The first is that since the foot is pronating (moving inwards at the ankle) this is trying to internally rotate the leg. While doing so the other leg is in the swing phase going forward and is wanting to externally turn the lower limb. The lower limb is ‘battling’ with these two opposing motions. Friction between the floor and the heel keeps the heel from moving. The instant weight begins to come off the rearfoot, the external rotation power from above can now abduct the rearfoot and it does so immediately. A second explanation is that there is a problem at the great toe joint in which it will not enable dorsiflexion correctly. This might be a hallux rigidus, a functional hallux limitus or a problem with the windlass mechanism which affects motion at the great toe joint. As that movement is hard to initiate, the body abducts the rearfoot to go sideways about this joint. A third explanation which is often only noticed in the physical therapy literature is that the observation is due to control over movement about the pelvis. In that literature it is usually described as a medial heel whip.

    The reason for discussion around the clinical significance is that it is simply an observation seen during a gait analysis that is because of different things (for example, the loss of friction from the ground, a problem at the great toe joint or the hip joint). If it is a concern, then treatment is directed at what is triggering the abductory twist or medial heel whip rather than aimed at the abductory twist itself. The treatment choices to do away with it is going to be very variable dependent on what is the best management choice for the cause.

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