A video case of a gait impairment. Chronic dorsal foot pain. This client came to see us recently. They had a current (2 year) history of dorsal foot achey/burning pain and anterior ankle pain, right greater than left. They had been just about everywhere for these complaints and were pretty much resolved that it was not fixable. They also had a chronic history of anterior shin splints. This is a pretty simple case. It is missed alot of the time. The reason it is missed is because nothing much shows up on examination. However, we used some tricks to bring out their symptoms. There are also some subtle hints on the gait video above but when you cannot pair what you see with what you find on a clinical exam the issues can get lost in the mix, as they did in this case. This is thus a case based much on clinical experience. We have seen this before. A great clinician (who's name we have forgotten) used to have a quote that went something like this: It is only after you have seen the beast once before that it will serve you well to be able to recognize it the next time. Having never seen the beast previously will leave you with a terrible bloody battle on how to slay it the first go-round." ln this video above you should basically see 2 things: 1. the easy one to see: the right foot immediately after toe off does not come forward sagitally rather it spins out into abduction in the swing phase to prepare for the next heel strike. 2. the harder one to see: both feet pronate immediately in the rear and mid foot excessively. This patient has some limitations in normal ankle rocker. More simply put, they cannot get enough adequate tibial progression forward into dorsiflexion over the talar dome. The squat test was really the only positive movement assessment that was confirmatory. As they squatted the ankle met early dorsiflexion restriction and thus the foot had no choice but to pronate early and heavily thus collapsing medially and drawing the knees in medially. Normally the arch should remain unaffected and the tibia should merely pivot cleanly and effortlessly over the talus allowing the knees to come purely forward. Not in this case. So, we have a client that has impaired sagittal mechanics. They cannot move through ankle rocker effectively and thus they cannot pronate in a timely manner. As the right foot leaves the ground at toe off they need to have sufficient ankle dorsiflexion to carry the foot cleanly forward to prepare for heel strike (this looks pretty good on the left in the video) but the right side is met with ankle range loss. If they did not circumduct the right foot like you see here they would drag their toes on the ground and likely trip. So, foot abduction is the strategy to avoid this issue. Howeve ... https://www.youtube.com/watch?v=uAtrftqaBrk