Do Your Feet Turn Out When Squatting or Running? (Updated 2024)

You and Your Feet

The foot is most stable when it is straight. When your feet are turned out, the integrity of your foot's arch is not being maintained. The further out you rotate your foot, inherently it tends to get less stable. As you stress out the plantar fascia, the flat connective tissues (ligaments) that connect the heel bone to your toes, the transverse and longitude arch will collapse without external rotation.

(2024: While most of this holds biomechanically, it raises an important question about demands during your activity. Does it matter if you’re increasing physical activity? How about compared to a marathon runner? The demands you ask of your feet will greatly determine how much the “correct” biomechanics matter.)

It is important to keep your feet pointing forward while walking and stable while lifting. If turned out of alignment, the knee and ankle will be open and the hip therefore be unstable. Instability can lead to hip, knee, or ankle problems or even skeletal issues like bunions or chronic knee and/or back pain.

(2024: Goes back to the first new point, which is task dependent. If you’re lifting 300lbs versus picking up a 3lbs box, these little “malalignments” matter less the lighter the load. In general, the question I ask is, can you do both? In reality, the inability to do one likely matters means more to our health in the long run.)

Hips or Feet?

Is the root of the issue coming from your hips or feet being turned out? A simple test can be performed by looking at the single-leg squat.

1. Set up a camera straight on

2. Stand on one leg and drop into a single leg squat.

3. Repeat on the other side.

Start by looking if any knee rotation occurs in or out but your feet appear relatively set. If so, the problem may be coming from your hips.

Do your knees remain stable, but your foot rotates in or out? Then it’s likely due to your feet.

Possibilities also include poor motor control, tight calves or an issue with your anterior tibialis (the muscle next to your shin).

The majority of cases I work with have exhibit some combination of the two.

(2024: All of that Is still solid advice in assessing the feet from the hips during an activity with increased stability demands.)

The Good News

The good news is that you can fix muscular imbalances and improve subsequent motor control discrepancies.

Walking

The most common way doctors choose to remedy this problem is with the use of orthotics. They artificially create stability through the feet, which works great until you have to shell out a good chunk of change for a new pair. An expensive solution to a problem that can be remedied by training the intrinsic foot muscles and improving internal hip rotation.

(2024: I am doubling down on the idea that too many doctors will refer to podiatry over consulting with a PT. This leads a patient down the rabbit hole of custom orthotics when in many cases, it could be resolved with intrinsic foot muscle strength work.)

Below is a whole post I created on Instagram around the topic:

View this post on Instagram

Build Stronger Feet 👣 - The initial shot shows maintaining a short foot-arch versus allowing the transverse arch to collapse. Collapse isn’t an issue, rather it’s uncontrollable collapse that is a problem. - Toe Control The ability to control your toes says a lot about the overall health of your feet and the muscles that cross the area. First begin by tapping the big toe up and down while maintaining the other four up. Then switch! Aim for controlled reps of 10. - Single Leg Balance Frontal Swings Taking the position from before maintaining your arch, now we add in movement making it more reactive in nature. Because the motion comes from the side, it’ll challenges you more dynamically. And dynamic stabilization is much more important because eventually you’ll have to test it out by running and cutting but initially this is where you begin building those intrinsic foot muscles. - Single Leg Balance and Reach An extension of the last exercise is a forward, side and backwards reach with the free leg. Good foot positioning allows the hip to do its job and by proxy aides proper alignment of the knee. - Concentrated Calf Raise Wall Nice and slow, we look to push through the ball of our foot up onto our toes, stabilizing via the big toe. If you can “stick” the position by pausing it’s a plus. - Single leg RDL w/ Band The band goes under the ball of your foot by the big toe. Proceed to add some tension to the band and perform SLRDLs. The goal is proper foot position, otherwise you’ll lose the band!

A post shared by Gary Heshiki (@garyheshiki) on Mar 7, 2018 at 9:04pm PST

It’s All in the Hips

Practice standing, walking, and running with neutral feet.  People watching in public places and see who walks/runs neutral and who has funky movement.  If you can spot the error in others than you will be more cognizant of your own movements. In most cases, being aware of the issue is more than half the battle.

Organizing our feet is easier if you are in a braced position as well.

(2024: ehh….okay there were a lot of nocebo statements made back when I wrote this originally. Primarily the idea that you can have a wide range of walking and running gait WITHOUT any pain. IF you develop pain, then we understand there might be a link loose in the chain. Otherwise, until there is some kind of reason to address anything, buyer beware when being told your position is why you’re in pain. Pain is far too complex to reduce it down to one singular cause.)

1. Being Aware of Your Balance

A few key components to achieve a neutral resting position (balanced posture) are the following:

1)  Engage your glutes (pelvis rotates posteriorly)
2)  Engage your abs (ribs rotate downward)
3)  Move your shoulders back and down (palms should be touching the side of your legs with thumbs pointing forward)
4)  Tuck your chin backward (like a turtle retracting its head back into the shell or double-chin)
5) Weight distribution (tripod positioning, heel, ball of the foot and outside of the foot)Internal hip rotators

Tension is held in the following: Calf complex, fibularis complex, bottom of feet.
Strength of: TFL, glute medius, glute minimus.

(2024: This is still gold, especially being aware that your ribs rotate in conjunction with your breathing mechanics. I will be exploring this further with more PRI studies)

Keep in mind there is no perfect posture, the best one is a changing one.

(2024: 1000% doubling down here, the best posture is the next one you take on)

2) Strengthening the Hips

My favorite movement to use is the RNT split squat. It works to train both hip and foot muscles in one movement.

Place a band around your knee and have it pull you INTO collapse which will force the muscles to engage harder and thus help groove the motor pattern. You can load it with a dumbbell or kettlebell in a goblet position at chest level for added resistance.

(2024: I still love these for individuals when they have poor spatial awareness during movement. Believe it or not, some people are unaware that they are allowing extraneous movement when they didn’t intend on it.)

Clamshells are a great exercise, big coaching cue is to make sure you aren’t rocking backwards as your open the hips. Think about keeping the hips stacked on top of each other.

Glute bridge variants are fantastic, you can start with the basic two legged bridge and progress to a single leg version, before trying things like marching or incorporating sliders.

• Improve general glute strength (single leg work like the RNT split squat, clamshells, Glute bridges)

• Strength in plantar muscles

• Strengthen dorsiflexion (mainly the anterior tibialis, your shin muscle)

3) Begin Mobilizing and Incorporating gait patterning

Single Leg RDL: Fantastic movement to train the hip in multiple planes of motion. Problem? It’s usually too hard on balance and subsequently a lack of tension in the right places.

(2024: Fun fact, the single leg RDL has one of the highest glute med EMG activation patterns. You can take that and run with it however you’d like.)

Here I’m performing a TRX assist SLRDL where you hinge back, and reach with your arms and hands forward and back. As you go further, you can spread the arms to widen your balance.

Seated 90/90 mobilizations: The full movement might be too difficult for some, you can work on the 90-90 shifts first

(2024: I disagree with this so much, that I am striking it through. Primarily as it disregards a larger point: can your hips even do this? What happens then is a person seeing this, trying to mimic the position instead of trying to understand the larger issue at hand which is the ability to feel proper motion from the correct areas of their hips)

Split stance kneeling adductor mobilizations: Good adductor length is important in maintaining good balance during lower body strength exercises. While it may not directly influence hip and foot dynamics, it can still have an indirect negative effect.

(2024: While I agree with my younger self here, adductor STRENGTH likely matters more than the mobility of your groin area. If you strengthen your adductors at both lengths, it will have a greater carryover to other activities all while increasing your mobility.)

Good ankle dorsiflexion: here is a whole post I made about this before.
First about good foot balance

View this post on Instagram

Foot Position and Improving Hip & Knee Stability - A follow up to last nights post about hip stability, tonight I’ll be tying in our feet to the equation. Our feet have the ability to help us drive up out of a squat or contour as an athlete dynamically cuts through a court or field. Our feet also have the ability to slow us down or decrease neural drive by losing ground contact. - •Our weight should be distributed somewhere between the ball of our foot to the heel. •Too much pronation, or loss of 4 outside toes decreases hamstring recruitment and shifts more onto the quads •Too much supination, or big toe off the ground and we get decreased quad recruitment with more work going to the hamstrings. - So where do you go after you improve intrinsic foot strength and/or hip stability: Loading it via resistance training. One way to check you’re ready for more is to change the angle of your feet - Start feet Straight Ahead •Start with the feet straight ahead, achieving subtalar neutral. •Squat down to a depth while keeping the ankle centered. •You’ll want to watch if the midfoot collapses inward during motion, squat to or beyond your desired depth. - Feet Turned out •Achieve a centered ankle position •Drop down to depth desired •This position is “easier” for your hips but often may come at the expense of foot or back position. In which case I’d argue this isn’t a good position for lifting •Hugely important during almost every sport which requires change of direction. - Feet Turned In •Turn the feet in with the ankle neutral •Drop down while paying attention to positioning of the knee throughout. •Important for athletics (a position many basketball players take off from when dunking) or weightlifting/CrossFit when athlete catch a barbell overhead during the jerk. - “Knees Out!” This is a really common cue. Instead coaches and lifters should focus on their feet. This is key because if your feet are neutral, you will automatically be using your hips to achieve that centered ankle position. Think about using your hips to help in getting to neutral, and often better knee-hip function will follow

A post shared by Gary Heshiki (@garyheshiki) on Jun 11, 2019 at 8:57pm PDT

551 Likes, 33 Comments - Gary Heshiki (@garyheshiki) on Instagram: "Foot Position and Improving Hip & Knee Stability - A follow up to last nights post about hip..."

Ankle PAILs and RAILs

1. Start by placing the ankle in as deep of dorsiflexion as possible. Then relax for at minimum 1 minute

2. Then start by contracting down towards the floor for 10 seconds as hard as you can manage (PAILs)

3. Immediately without changing positions, try to pull your foot up towards your shin. Even if no movement occurs, continue pulling. It’s all about intent (RAILs)

4. Then relax into the new end range and repeat 2 more times. You can begin the PAILs contraction once you feel like the tissues have “relaxed”

View this post on Instagram

A post shared by Gary Heshiki (@garyheshiki) on Jul 8, 2019 at 9:09pm PDT

2024: Ultimately, a lot of this still holds true but I would approach changing anything with some trepidation. Not everyone needs “fixing”, in general the rule of thumb needs to be when there is no problem being reported, don’t go out searching for one. And run the other way if you’re being sold that there is.

Why You Need to Lock Your Knees Out

Photo by Meghan Holmes on Unsplash

Lock your knees out. Especially when you lift!

But have you heard the advice that you shouldn’t lock your knees out because it’s bad for you? Ever wonder why that is?

This myth has origins in stories of soldiers standing at attention for hours on end only to end up fainting as they had their knees locked out. It was postulated that this was due to compression of the popliteal artery (a branch from the important femoral artery).

Secondarily, this also centers around old beliefs about arthritis and how excess wear and tear might cause a breakdown. Instead, researchers now are finding it may not be a disease of breakdown but rather uncontrolled local inflammation in the knee joint. (1)

Screw-Home Mechanism

The screw home mechanism is an integral part of ensuring good knee stability. For most healthy individuals this is something you don’t think much about. However, for anyone with prior operations or lingering anterior knee issues, this is an important concept to understand around general knee function.

The medial condyle is 1/2 in. longer than the lateral condyle. This allows the femur to screw home when fully extended and this stabilizes the knee joint. This is an essential aspect of being able to walk and support yourself during the swing phase (Standing on one leg while the other one swings through).

The movement of internal rotation of the femur on the tibia associated with the later stages of extension of the knee constitutes a locking mechanism, which is an asset when the knee is subjected to strain.

In general, it works like this:

• Closed chain (like squatting) the femur moves on a stable tibia (shin bone). (2)

  • The Femur rotates externally to unlock the tibia.

  • The femur rotates internally to lock on the tibia.

• Open chain (like a leg extension) where the tibia moves on a fixed femur. (2)

  • Tibia internally rotates to unlock

  • Tibia externally rotates to lock

I Don’t Have Knee Problems…Why is This Important?

• Most knee problems occur at the terminal extension with a lack of VMO function. Ah, for some, I’m sure you recognize the VMO, this is why so many coaches prescribe terminal knee extensions. Why isolate one motion when you can easily train this whenever you hit leg day!?

• As you flex your knee, the PCL relaxes and the ACL is tightened. The reverse is true, as you extend your knee the ACL tightens and contributes to stability while the PCL relaxes(3). Seems important to ensure these structures are exposed to stressors so they can improve stabilization (albeit minimally).

• If you lack terminal knee extension, you will likely rely on a few strategies.

  • Think of an elderly person who shuffles their feet. They can’t lock their knee out, therefore, decreasing the amount of time they stand on one leg during the gait cycle. So they shorten that time by shuffling their feet instead.

  • You can’t lock your knee out, you either walk with more flexion and increase stress on other structures or you walk with some limp. A limp also increases the reliance on other structures, namely your hips to help keep this show running.

• This is why you may not need to squat “ass to grass” but you do need to expose your knee to deep flexion to end-range extension. Pain-free deep flexion tells our brains via our receptors in the deep knee capsule stuff to maintain these structures. This in turn supports our ability to access such positions.
  

  The easy take-home is to do leg presses or lunges maybe. It doesn’t have to be heavy, it just needs to be deep.

Lack of Internal Hip Rotation Relates to Low Back & Hip Pain

Improving internal hip rotation is important for a variety of reasons including:

• It allows us to go into a deep squat position safely

• Key contributor to knee and low back pain

• Poor movement for rotation sport athletes like baseball or even golf

• For runners, it doesn’t allow the athlete to extend the hip to engage the glute.

Hip IR should be tested in two positions, because different structures can limit your range of motion depending on whether the hip is extended or flexed. The second test is actually a mobilization for improving hip IR if and when progressed properly.

Testing Seated Internal Hip Rotation

Sit at the end of a table, with your knees bent over the side, and hold onto the table itself.

Now internally rotate the hip, without abducting or side bending, which is a sign of compensating with the lower back.

Generally speaking 35 degrees is good in the general fitness population and 40-45 degrees in competitive athletes.

A quick check to see if you may simply have a "lazy" side if one leg has better hip IR than the other. Perform a side plank on the side that's lagging and reassess. It should improve if it's simply an activation problem, otherwise it helps to narrow down the problem to a structural/muscular or alignment (though not very common) problem. 

Mobilizations to Improve Hip IR

Kneeling Glute MOB

• Set up on all fours with hands under the shoulders and knees under the hips.

• Maintain a slight arch in the lower back and place your right foot on the back of your left knee.

• With your back set sit back into your right hip and hold for a 1-2 count before moving back. Perform 5-10 reps on both sides.

Lying Knee Pull Ins

• Lie on your back with your knees bent and your feet flat on the floor.

• Exaggerate the width between your feet.

• Think about trying to internally rotate your femurs which as a result have your knees touch together while keeping your feet on the floor. Hold for a two count and return to the starting position. The stretch should be felt in the hips and not the knees.

• Perform 8-12 reps before working out.

• Good for those with muscular restrictions.

Prone Windshield Wipers (TEST #2)

• Lie on your stomach with your knees together and feet up in the air.

• Keeping the knees together, let the feet fall out to the sides.

• Hold for a two count and return to the starting position.

• Perform 8-12 reps prior to workout.

• This is great in particular for those with a capsular restriction.

Passive Internal Rotation Stretch

This goodie comes courtesy of Dean Somerset. This is more of an advanced stretch and would be sure to be able to knock out all the above aforementioned ones before using this one to help maintain proper hip IR.

• Sit at the end of a table or elevated step and lift one leg back into internal rotation as shown.

• Progressively work your work close to the table, and hold for 30 seconds.

• Repeat on the other leg.

I hope that this post will help steer you in the right direction to improve your lifts in the gym and your times on the trail.

If you should have any specific questions please shoot me a message and I'll be happy to try and help out. If any of this information was insightful, helpful or funny please share it with a friend!

Social Media: Where Pros Give Unsolicited "Advice"

It's late one night and you're scrolling through a social media feed on your phone and come across some friends working out. Like most individuals you might give them a like or comment about how that's awesome or congratulating them on a new accomplishment in the gym.

You go to the comments and see:

"Not hitting depth, smh"
"I'd be careful, your back shouldn't be like that"
"Shoot your hips back more and focus on arching"
"Leg drive! Arch! You'll push more once you learn to do that"

The "Fit Pro" Commenth

You click on the profile of the individual who left one of these types of comments and discover they're trainers and coaches who've decided they know best on how EVERYBODY should train.

Now I'm not talking about the fitness enthusiast who fancies themselves an uncertified trainer because they have a six pack or competed in a powerlifting meet. I'm talking about a true "professional" who puts food on the table training others. These are the guys I have a gripe with. I used quotes because these "pros" aren't very professional. 

Here's why it's a load of bull for one fitness "professional" to call out another publicly on social media.

I'm ACE, NASM, NCSA, ISSA, ABC123 CPT

While you may not agree with what you're seeing, it's also not your job to be judge and jury for all things fitness simply because you passed the most rudimentary of Personal Training certifications. Nor does ripping off someone else's training philosophy and system suddenly make you an expert. As a professional it is your job to help YOUR clients and contribute to the fitness industry. It's easy to move on and not waste your time being the form police. Instead of tearing others down why not be a positive beacon building others up by reaching out. Don't try and hijack someone else's feed by putting them down and trying to show how superior you are and why they or their followers should add you, they won't.

Did it ever cross your mind that the person you're critiquing is the very person in the video, a person who is NOT a professional but a paying customer? Now I know what you're thinking, hey if that coach did a better job the client would be moving better. Heres the problem with that line of thinking. You have no context as to how long this client's been training and more importantly how much progress said client has made.

While you may be watching someone perform a squat to a less than desirable depth or deadlift with a slightly rounded back, you didn't know that the coach wanted the client to be focused on hip positioning today. They're crushing their hip position and in time I'm sure they'll fix that back position as well. This often can be the case for very untrained individuals because they can easily become overwhelmed with dozens of cues and checkmarks. A good coach breaks things down into easy manageable steps. Sharing progress is that, progress and not the final product. Critiquing the technique of a beginner is as ridiculous as over analyzing a T-ball swing, really man what are you doing?!

Social Media Crusader

Here's my biggest gripe I have with other fitness "professionals" criticizing other pros via social media: Your critique can be the sole reason another person loses business and is unable to keep the lights on in their home. Said client may read your comment and decide that maybe their trainer isn't good and decides to stop. While you may think you're doing a service to the industry, all you're doing is a being a jerk. I've meet thousands of trainers, some good and some needing more CEU's, but for the most part they've been good people. Judging others coaching abilities isn't up to you! Who are you to be reaching in and taking money out of somebody else's pockets?! Don't be upset with them, be upset you aren't better at marketing your services to help more people. 

I firmly believe the cream rises to the top. If a coach is good they'll succeed on their own, just like they'll run themselves out of business all the same if they don't deliver results. It shouldn't be because you're planting the seed of doubt into their client's head. Yes sometimes these coaches have their clients performing less than stellar technique on a regular basis but also remember that their poor training only highlights how good you are without saying a single word. 

If you really feel the need to criticize another coach, for all that is good and holy just send them a private message.

Lastly lets stop being lazy with these bot comments and copy+paste DM's. I get you're trying to build up your following but you're trying to do so by being lazy and trying to take a short cut. Some of these comments don't even make sense, I'd ask for a refund for that bot if I were you.

I continue working on my own social media presence, it takes work and if you're a true professional, you'll be working on it yourself. 

Personal Training and Massage

Walk through your local gym you'll see dozens of personal trainers stretching their clients. No doubt this has been going on forever, but is technically outside of the personal trainer's scope of practice.

Scope of Practice- Procedures, actions, and processes that a healthcare practitioner is permitted in undertaking. 

Scope of Practice for Personal Trainers (according to NSCA)

 "Developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” 

Nowhere in there does it mention any sort of muscle manipulating techniques.

Ouch That Hurts

Hey can you move back to that other spot...a little lower....YEAH! OUCH! You got it. 

This was a typical exploratory palpation session with clients whenever they were unable to release muscle on their own and so it made sense for me to get it out for them so we could get back to training. When I started doing bodywork I had already been a trainer for over 5 years and was decently versed on anatomy and biomechanics.

This all is a rationalize for what I was doing, which was outside the guidelines of my liability insurance and scope of practice. The results I got were positive across the board, but I also knew I wasn't allowed to do what I was doing. The more injuries I would encounter, the better I got at feeling healthy tissue and fibrous restrictions in the fascia and muscles. Though in the back of my mind I knew what I was doing was illegal.

I observe dozens of coaches, many of whom I see jam their elbows and fingers in areas where they shouldn't be. And not because now that I'm a manual therapist I'm on my high horse but because they're actually pressing down, rather hard I might add given the discoloration of the skin around said area, into a place where there's way too many nerves or organs.

Pot Meet Kettle

I will never tell any other coach they shouldn't be placing their hands on their clients, because that would make me a giant hypocrite. I do however advise these coaches to exercise ALOT of caution. In an effort to add value to sessions coaches range from the harmless assisted static stretching to downright dangerous let me dig my elbow into your anterior triangle. 

What I've Learned

I Didn't know WHY only how
A Manual therapist, massage therapist or LMT has undergone more extensive training than personal trainers where it pertains to understanding of how and more importantly WHY to work in a given area. They learn more manual muscle testing and specific assessments to address movement compensations. I could copy a technique but didn't fully grasp the methodology behind it.

Most trainers who perform assisted soft tissue via foam roller, ball or roller stick think: harder is better. It's not.

Getting work done on you doesn't in turn show you how to treat your clients
Copying a given technique performed on you might help YOU, but could injure your client. In the same way you wouldn't give a 65 year grandma the same exercise protocol a 25 year old would receive, the same goes for soft tissue manipulation. In the past I've seen coaches receive a quickie treatment only to see them performing the exact thing on their clients that same evening.

I hadn't earned the right to put my hands on clients. Trainers are not therapists.
Many colleagues who are both manual therapist and trainer had to juggle massage therapy school and a full slate of clients at the same time. Depending on where they're located, schooling can range from 500 hours to over 1000 hours. And while this may be a lot or a little depending on how you look at it, it's a large commitment for anyone with full time obligations. 

Trainers are not physical therapists. Most of the corrective exercises seen today don't work because the coach implementing them lack an understanding that the issue needs both manual therapy and corrective exercise.

I of course will not fool myself thinking that I am anywhere near the level of a DPT (Doctor of Physical Therapy) either. I always had a firm grasp on anatomy, or so I thought. I came to see that I lacked a comprehensive understanding of:

• Origin and Insertion sites
• Layers above and below muscles
• Feeling the difference between muscle and organ
• Progressions for treatment
• Contraindications with degenerative and acute diseases or injuries

I understand now I had not earned the right to put my hands on a single client because I had not committed to fully understanding the topics above. I had not put in the time, literally. I thought because I could recite muscles and actions off the top of my head that I could manipulate muscles. I was wrong. On one hand all the clients I've helped has allowed me to get a head start on my education in treating soft tissue restrictions but I also understand I probably shouldn't have ever laid a hand on a single person, no matter the outcome.