Excessive foot pronation is visualized by three potential observations: excessive calcaneal eversion, medial midfoot collapse, and excessive toe out. Abnormal foot supination is visualized by calcaneal inversion, excessive medial midfoot arch height, and disproportionate weight bearing on the lateral foot. Large callus formation may develop under the first and fifth metatarsal heads.

Excessive toe-out posturing in stance phase may represent compensation for hallux limitus, ankle equinus, excessive tibial external torsion, or excessive foot pronation. Toe-out walking patterns place increased medially directed elongation stresses and laterally directed compressive stresses along the soft tissues of the ankle joint. Excessive toe-in posturing in stance phase represents most commonly metatarsus adductus or excessive tibial internal torsion.

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Gait assessment of running includes all of those previously described with attention given to initial foot strike. First foot contact may be observed at the calcaneus, midfoot, forefoot, or toes. Early-stance phase heel strike enables ankle joint dorsiflexion and foot pronation to provide weight-bearing loading and shock absorption. Forefoot and toe strike as the initial foot contact is the norm in running sports’ requirement for speed and change of direction. Prolonged straight-ahead running with forefoot and toe strike as the initial contact relates to decreased shock absorption capability (Deppen, 2007).