Fixing your knee and foot pain by addressing your hip!

You realise one day that your feet are turned out when you walk, run and stand. You compare yourself with your friends and wonder if it is normal. Well, I am here to tell you that there isnt really a ‘normal’. All hips are different, your hips might even be different from left to right.

For that reason, all hips are treated differently as well.

Whether your feet are excessively turned out or in, there could be a few reasons.

It could either be caused by the bone structure of your femur or acetabulum, or it could be caused by soft tissue imbalances.

Let’s address bony structure variations

Femoral retroversion and anteversion. Retro-version, is when the neck of the thigh bone is twisted back, and ante-version is when it is twisted forward.

3D CT SCANS

Retroverted

Craig’s test

You will need someone to help you with this. Lie face down, on the leg being tested, your therapist or friend bends the knee to 90 degrees. Feel for the greater trochanter, the big bony ball on the side of your hip. If you turn the knee in and out you will feel this bone get bigger and smaller. If the greater trochanter feels the biggest with the leg turned inward, then you have a retroverted hip. If more than 15 degrees outward, that is an excessively anteverted hip.

The normal angle of torsion should fall between a window of 8-15 degrees of internal rotation (tibia shaft away from the midline).

Having performed the craigs test, Image a shows an anteverted hip. Image b shows a retroverted hip. Image c shows a hip within “normal” ranges.

Acetabular retroversion

• CT scan

• Image illustration

• How to test

Reasons for outward facing feet

• Femoral anteversion with tibia external rotation as a compensation.

Our bodies have the ability to adapt, it compensates in any way it can in order to achieve what we are trying to do. In this case, because the hip bone is turned inwards, (as shown in the picture above, labeled “knee facing forwards” on the Right leg) the lower leg turns outward in order to balance out the rotation. This results in the foot pointing outwards as well, giving a duck walk-like appearance.

• Retroverted acetabulum causing the entire leg to be facing outwards.

In another case, it is possible that the hip socket is turned outwards, hence resulting in the entire leg being faced outwards, shown in picture above.

This could be the cause of your knee pain, plantar fasciitis and or a clicking ankle.

• Explanation on how the structures are stressed

Below, Marcus talks about how these compensations and bony variations can cause secondary issues, he also shows us how we assess these conditions and some treatments we can consider.