PT on the Net Research

How Many Degrees Should the Feet Point Out?


Question:

Some research places a large focus on ensuring that a client's feet point straight ahead and state feet that deviate from straight ahead are caused by muscle imbalances. However, other authors state that the anatomy of the ankle joint means that the feet should point out five to 15 degrees, and in one article, Paul Chek states that the feet can point out up to 30 degrees. Which one is correct?

Answer:

Well, of course, I'm correct! :-) The answer can easily be found in a number of places, none of which include typical training manuals for exercise professionals, as you will now see. Let's look at the facts:

  1. If you look at the book Biochemical Individuality by Roger Williams, Ph.D., you will see some 19 different stomachs from human beings. The book is absolutely loaded with the hormonal, chemical and organic differences between so-called "normal" individuals. It quickly becomes evident that we humans are as different on the inside as we are on the outside.
  2. The Textbook of Kinesiology by Arthur C. Steindler shows the tremendous variance in such (relevant) things as femoral neck angulation, differences in the acetabulum, femoral torsion, tibial torsion, etc. In this world class kinesiology text, one quickly learns that not only are we humans significantly different from one another, but we are very different from left to right within our own bodies!
  3. To date, I have done five cadaver dissections. During these dissections, it became very apparent that there can be tremendous differences in symmetry, bone length, density, wear patterns, torsions, cartilage thickness in joints on either side of the body, the size of bony prominences from left to right and much more.
  4. The famous British physiotherapist by the last name of Grieve once published a paper describing the unreliability of bony land marks used for mechanical assessment in physical therapy. He based his findings on cadaver analysis. He showed clearly that one can't rely on bony landmarks to accurately asses but must rely on skillful assessment of joint movement and mechanics.
  5. Having studied posture extensively, I was interested many years ago in how the so-called "posture dictocrats" came up with their norms for bony landmarks and all the so-called "normal" alignment factors described around the issue of normal or ideal posture. Interestingly, I found articles from the 50s that described how postural norms were developed by laying dead bodies on tables in a morgue and measuring their orthopedic alignment.

That said and considered, I can only suggest you do the following. Ask 10 to 20 people without pain to:

  1. March on the spot with their eyes closed and give them the command to stop marching after 20 seconds or so. Look to see how many (if any!!) have their feet parallel. Now, since there aren't many normal people left in the world, I can share this with you. In every third world country I've visited, I've looked carefully at the native children, who in most cases were eating their natural diet and were getting plenty of exercise. Never yet have I seen someone with what I call "railroad track orthopedics!"
  2. Have 20 of the healthiest people you can find squat down. Make sure they are relaxing into the squat enough that their hands can touch the ground (like they are designed to). Then, give the command to stand and NOT move their feet once they stand up. Now look down at each person's feet, and you will see that none of them meet the so-called alignment standards set by researcher or organization! Why? See 1 through 5 above!

I would like to close by sharing this simple fact: to perform a proper orthopedic assessment requires a lot of training by a skilled teacher. It requires a comprehensive understanding of how all of the body's control systems work together to control orthopedic function. It requires skilled assessment with goniometers so you can determine key markers, such as head carriage, 1st rib angle, spinal curvatures, active and passive joint ROM and comparative ROM. Joint end feel must be assessed. Length/tension relationships in the musculofascial unit(s) and the health of the soft tissues in general must be assessed. The function of the nervous system must be assessed... and so on. It is a GROSS error to tell someone to stand a specific way when you are to load his or her body in any way without having completed a comprehensive assessment to determine:

If, for example, you have someone with asymmetrical femoral neck angulation, femoral torsion or tibial torsion stand the way trainers often tell them to (i.e., feet parallel), there will be a torsion created within all the joints in that kinetic chain. Since in a squat, the feet are firmly attached to the ground, as the individual squats, the torsion must move upward through the kinetic chain. The result(s) will be that the torsion will have to be dissipated at the place most available or suitable in each individual instance. Clinically, I have seen hyper-mobility of the sacroiliac joints, lumbosacral instability, spinal instability, rib pain and neck pain alleviated by simply teaching people how to find their unique squat or deadlift stance.

If one wishes to apply such cookie cutter approaches as you are questioning here, I suggest getting a job as a baker, for in that profession, there is no cost to breaking the mold. When working with human beings, you are working with highly individualized, unique beings for which there is no mold!

A simple rule I teach my students is, "If it looks bad, it probably is, so check it out!" Each exercise professional must operate within his or her skill set, but at no time should one stop thinking logically or rationally or they will be apt to stop using their own mind. Remember, just because something is written in a book doesn't make it true, reliable or even worth reading. The very fact that you've asked the question suggests your rational thinking processes are working. Congratulations!