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The Abductory Twist

An abductory twist is anobservation that is often noticed during an observation of the running or walking gait. Just as the heel begins to off-load or come off the ground there is a quick sudden abduction or twist seen with the heel. It is a frequent observation when doing a gait assessment, however its clinical relevance is the source of some argument.

There are a number of explanations for an abductory twist. One is that as the rearfoot is pronating (moving medially at the ankle) this is wanting to internally turn the leg. At the same time the other leg is in the swing stage going forward and is trying to externally turn the lower limb. The lower limb is ‘battling’ with these two opposing forces or motions. Friction between the ground and the foot keeps the heel from moving. The instant load begins to come off the heel, the external rotation push from above can easily abduct or whip the rearfoot and it does so rapidly. A second reason is that there is a condition at the great toe or hallux joint in which it fails to allow dorsiflexion adequately. This could be a hallux rigidus, a functional hallux limitus or a problem with the windlass mechanism which affects motion at the big toe joint. As that motion is difficult to initiate, the body abducts the rearfoot to go sideways around that joint. Another explanation that is only usually mentioned in the physiotherapy literature is that the problem is because of control over motion around the hip. In that literature it is usually described as a medial heel whip.

The reason for discussion about the clinical relevance is that it is just an observation found when doing a gait evaluation that is brought on by something else (for example, the loss of friction from the ground, a problem at the great toe joint or maybe the hip joint). If it is a problem, then therapy is directed at what is causing the abductory twist or medial heel whip instead of aimed at the abductory twist (or heel whip) itself. The management choices to do away with it is going to be very diverse depending on what is the ideal treatment choice for the reason is.

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