July 14, 2008
Numerous factors -- including the structure of your hip and leg, whether you have flat feet and even the shoes you wear to work out -- may affect the position of the foot during activities, says podiatrist Neil B. Mansdorf, president of the Orange County Podiatric Medical Assn. In fact, 15 degrees of external rotation of the foot is considered normal.
Sometimes the hip is positioned so that the leg turns outward naturally when walking, Mansdorf writes in an e-mail. Excessive external rotation may be helped by the use of orthotics. Rarely is surgery necessary.
Another possibility is that the position of the lower leg may not be sufficiently externally rotated, or turned out. "Although this seems contrary to the reader's complaint," he says, "the compensation for a lack of external rotation of the lower leg may result in the heel twisting outward from beneath the leg." This could cause a flattening of the arch and external rotation of the forefoot. This type of compensation will also give the appearance of a foot that is turned out.
The problem could also stem from having flat feet. "A flat foot, or what is referred to as a pronated foot," he says, "occurs as a result of the heel everting (twisting out beneath the leg) and the arch of the foot collapsing. As the arch collapses, forces during gait may push the front of the foot outward in an externally rotated position, thus giving the appearance of a foot which is twisted outward."
Is there any pain associated with the foot position, or is there any pain farther up the leg, including the knees, hips and spine? Any pain in the foot or leg, especially pain that does not resolve within one week, should be evaluated by a specialist.
Here are other some things to keep in mind, Mansdorf says:
* Methods to treat foot and leg conditions vary from things as simple as just changing the shoe style to surgical correction for a structural deformity.
* Shoes are often the easiest thing to experiment with, and they have a tremendous effect on the function of the foot.
* The best all-around shoe for most running, walking and training activities is a good running shoe. However, Mansdorf recommends a sport-specific shoe for individuals regularly performing a specific activity, such as tennis or basketball.
* The shoe should not fold in half across the middle of the arch, nor should you be able to wring the shoe out like a towel. The more pronated the foot, the more stability is necessary in the shoe to resist the abnormal forces of the foot.
Shoes range from types termed "cushioning," meaning a softer shoe, for the high-arched foot, to "stability," meaning a stiffer shoe for the average to mild or moderately pronated foot, to "motion control" for the heavy over-pronator. An individual with an externally rotated foot may require a shoe in the "stability" to "motion control" shoe range.
Shoe inserts may also help, Mansdorf says. These include cushioned insoles, prefabricated arch supports, heat-molded arch supports as well as custom molded orthotics prescribed by a professional. Some of the prefabricated devices work well at controlling the abnormal foot position when used in conjunction with a good shoe. But in many cases, the prefabricated devices may not be enough to control the foot position -- in which case, custom orthotic devices may be necessary.
If your foot position has remained the same with time and you are not experiencing any pain, then experimenting with shoes and prefabricated insoles may be the first step. If, on the other hand, your legs and/or feet have been progressively changing in position and shape, or there is any pain associated with activity, you should see a professional to get more information as to what shoes, insoles, orthotics and muscle strengthening exercises or even surgical correction would be most appropriate for your condition.
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