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Abductory Twist

An abductory twist is a characteristic of gait that is commonly observed by clinicians. Many people when they are walking, just as the heel comes off the ground there is a sudden and small movement of the heel medially (abduction). Many clinicians do not consider this to be of much significance as it is just a sign of an underlying problem rather than a problem on its own.

There are many different causes of this abductory twist. One is that the big toe joint must dorsiflex or bend just as the heel comes of the ground so that we can move forward. If that joint does not want to bend, then the foot will abduct to get around the block at the joint. Another common cause is overpronation of the foot. This is when the foot is rolling inwards at the ankle joint and the leg is externally rotating trying to roll the foot outwards. As soon as the heel comes off the ground the foot suddenly abducts due to the twisting.

A medial heel whip is something that does get confused with an abductory twist, but they are different. The twist occurs just as the heel comes off the ground and the whip is more of a circumduction of the whole foot as it comes of the ground. While the twist and whip are in the same direction, they are very different things and caused by different problems.

The abductory twist does not need to be treated as it is not a problem on its own. It is caused by something and that something is the cause of the problem, so that needs treating rather than just the abductory twist. The treatment will need to be directed at either the cause of a block in motion at the big toe or the cause of the overpronation of the foot. This means that the treatment may take on many different possible alternatives, so there is no one treatment for it.