Hmmm. We are fully internally rotating this gentleman’s lower leg (and thus hip) on each side. What can you tell us?

Look at the upper picture. Does the knee go past midline? NO! So we have limnited internal rotation of the hip. What are the possible causes?

• femoral retro torsion
• tight posterior capsule of hip
• OA of hip
• tight gluteal group (max or posterior fibers of medius)
• labral derangement

Now line up the tibial tuberosity and the foot. What do you see? The foot is externally rotated with respect to the leg. What are the possible causes?

• external tibial torsion
• subtalar valgus
• fracture/derangement causing this position

Now look at the bottom picture. Awesome forearm and nice choice of watch. Good thing we didn’t wear Mickey Mouse!

Look at upper leg. Hmm. Same story as the right side.

Look at the lower leg and line up the tibial tuberosity and the foot. What do you see? The foot is internally rotated with respect to the leg. What are the possible causes?

• internal tibial torsion
• subtalar varum
• fracture/derangement causing this position

So this individual will have very different lower leg mechanics on the right side compared to the left (external torsion right, internal left). We refere to this as “windswept” biomechanics, as it looks like the wind came in from the right and “swept” the feet together to the left.

What will this look like? Most likely increased pronation on the right and supination on the left. What may we see?

• calcaneal (rearfoot) valgus on right
• calcaneal (rearfoot) varum on the left
• bilateral knee fall to midline
• knee fall to midline on right occurring smoother than on left
   (the patient has an uncompensated forefoot varus bilaterally; he is already partially pronated on the right, so it may appear to be less abrupt)
• toeing off in supination more pronounced on the left (due to the internal torsion and forefoot varus)

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