Have you ever been squatting and noticed yours or another athlete’s foot turning out (physically externally rotating) under them? The toes angled out in a squat is relatively normal when it comes to an athlete’s squat mechanics, but what about the physical rotation of the foot?
How much is this a real problem for an athlete’s performance and lower limb health? After all, if there’s no pain or sign of injury, then could it be that it’s just their body’s natural way of moving. Without context into the athlete’s previous training, current training, and goals, there could be multiple reasons contributing to the foot rotating under the squat.
Editor’s note: The answers below and rationale from within are of Dr. Jordan Feigenbaum’s and don’t necessarily reflect the views of BarBend. Claims, assertions, opinions, and answers below have been provided exclusively from Dr. Feigenbaum.
To help explain this situation further and answer a few questions on the topic, I reached out to Jordan Feigenbaum MD and founder of Barbell Medicine. I wanted to know how much of a real issue this was, what could be the cause, and what to do about it. If you’re interested in this topic, then sit back and read on because Dr. Feigenbaum provides a unique approach to this scenario in his answers below.
What does it mean (generally) if the feet are turning under you during a squat?
Defining the Mechanics
It is important to be precise when discussing biomechanics of a movement, so we need to define what we’re talking about here. In many lay articles, authors refer to this movement as the “toes turning outwards,” but what does this actually mean? Movement of the entire foot when the sole is in contact with the ground is principally describing lateral or medial rotation, which refers to the toes and forefoot angling outward or inward from the body, respectively.
Additionally — and more specifically — there can be elements of pronation and eversion when the foot rotates from pointing straight or near-straight ahead to pointing outwards, as the hindfoot (heel) rotates inward and the forefoot (toes) rotate outward while the ankle joint participates in dorsiflexion.
Let’s consider the following case:
30 year old untrained injury-free male with no past medical history presents to the gym to start a strength program where he will be squatting three times per week. It is gym policy that he meet with the head trainer prior to being allowed to use the gym without supervision for an initial assessment. During the assessment, the head trainer instructs the untrained lifter to “do a bodyweight squat” with his feet hip-width apart, toes straight forward, and hands over his head. The lifter performs the squat as instructed and his feet rotate outward in the manner described above. What is the best course of management for this lifter?
Now, many of your readers will be under the assumption that the toes rotating out during the squat is a fault or potential imbalance that may cause injury or reduced performance if left untreated, however the evidence to support this assumption is severely lacking.
At present, multiple movement screening tests (e.g. the Functional Movement Screen or “FMS”) have not been validated at assessing what they claim to do and do not reliably predict injury rates. While a few prospective studies looking at athletes have suggested that certain cutoff scores for the screening tests do correlate with incidences of injuries, they also report fairly low sensitivities of those cut off scores.
What the Research Suggests
For example, a 2007 study by Kiesel et al. looked at 33 professional football players who were subjected to the FMS during during preseason and concluded that those who had a FMS score of >14 were at significantly less risk of sustaining a serious injury than those with a score of <14. However, the reported sensitivity was about 50% (54% to be exact), which means the injury rate was nearly the same in those with scores >14 as those with scores <14.
These results are not unique, as the majority of the current data fails to show useful screening techniques for predicting injury in sport and there are no studies addressing the implications of screening scores on performance. Furthermore, there would need to be specific things that a coach would do in order to address the deficiencies identified by the screening test in order to reduce injury. At present, the only things that reliably reduce injury rates are increasing strength and making sure the athlete has sufficient enough time to acclimate to the practice and competition stress, whereas stretching, manual therapy, etc. do not effect injury rates, subjective ratings of soreness, or objective performance reliably.
So, how does that effect what I think about foot movement during the squat? Well, it seems to me that screening for mobility issues in the ankle, hip, knee, or other joints in order to assess whether or not someone can squat is a waste of time for three reasons:
- Reason 1: They cannot reliably tell you anything about the lifter’s risk of having a musculoskeletal injury during training or their performance potential.
- Reason 2: Anything picked up during the screening test does not affect management because stretching, soft tissue work, or special prehab/rehab techniques aren’t going to work unless they have the lifter practice the movement they’re about to do or it makes them stronger.
- Reason 3: A lot of the “flaws” seen in these non-validated, unreliable screening tests magically disappear with proper coaching of the lift, i.e. adjusting the lifter’s stance width, toe angle, bar position, and mechanics to better suit their anthropometry.
No amount of foam rolling, band distraction, Graston, Rolfing, ART, hyperbaric chamber, stim, ROMWOD, or ankle mobility drills that don’t involve actually squatting are going to improve the mechanics of a lifter’s squat long term — so why not just squat?
The Likely Reasons Feet Are Rotating In the Squat
To answer the case study prompt and the initial question of — “What does it mean (generally) if the feet are turning under you during a squat?” — it means nothing in particular. Rather, the most likely causes of the feet rotating outwards during a squat are as follows (in no particular order):
- Stance too narrow.
- Lack of coaching. If you do not know that you should’ve tried to keep your toes pointing straight forward during this squat — a squat that is impossible to perform under any actual load and cannot be used in training (see: The history of all barbell sports) then perhaps the lifter did not make a conscious effort in keeping their toes straight ahead.
- Insufficient mobility in the one of the lower limb joints to perform the arbitrary test.
Now, I know what you’re thinking, “Aha, mobility….time to stretch!” Not so fast. If the screening movement cannot reliably predict injury risk, performance potential, or technique considerations and it is not the same as the training movement what value does it have?
Even if you could stretch, mobilize, and drill the lifter into the perfect position for the screening test, why would we sacrifice training resources to do so given that the test is meaningless? Furthermore, I would argue that general stretching, mobility drills, or therapy do not improve the performance on the test unless they are very similar to the test itself. Stretching works by reducing fear and improving tolerance of a position, i.e. when practicing the splits one gets better at doing the splits overtime because of a reduced fear of the position (and only this position), but that doesn’t do jack for their squat or this assessment (unless it was the splits).
Mobility drills that do not resemble a squat cannot improve the squat unless they make the person stronger, i.e. make the muscles produce more force. If the tissues are not loaded in a progressively overloaded manner, this cannot occur. So in sum if we wanted our lifter to perform better at this test then he would practice the test.
Do rotating feet mean an athlete should lay off barbell squats and opt for fixing the issue before continuing their normal sets?
I think that the first thing a lifter should do is see a competent coach who can adjust their stance width, toe angle, bar position, and mechanics to something that suits their anthropometry. There’s no reason to try and jam a square peg in a round hole.
For example, if we have a lifter with very long femurs, a short torso, and long arms then we will likely see issues with their front squat, which ultimately limits training efficacy (i.e. muscle, strength, and performance improvements over time). Therefore we might pick a different squat in order to have them train their squat productively instead of spending months screwing around with a front squat unless it’s something they have to have in order to make a living (or get the girl).
We have many options for squatting techniques and styles, so it is likely we will be able to find one suitable for nearly any anthropometry.
What is something an athlete can start doing right away to help remedy the issue of turning feet?
They should assess their stance width and toe angle first. A general rule of thumb is to start with the heels shoulder-width apart and toes pointed out at 30 degrees or so. This is only a starting point and some folks will need a slightly narrower or wider stance with slightly more or less toe angle depending on their anthropometry. Spend the time doing this instead of “working on mobility” that’s not going to work anyway.
Second, they should try lifting shoes of various different heel heights. While most have effective heel heights of 0.75”, there are also shoes with 1” (Adidas Leistung), or 0.6” (Adidas Powerlifts) that may work better for some. Some of this has to do with support of the foot arch itself with the in-compressible sole and metatarsal strap, whereas some of the benefit comes from changing the plane of the ankle joint so that their present amount of dorsiflexion is sufficient.
Again, I know someone is saying, “Dorsiflexion! Flexibility! You can increase dorsiflexion by stretching the ankle!” No, you cannot — at least not for long. The best data on this shows that neither PNF nor static stretching increase the mobility for longer than about a day and it does so in a non-specific way, i.e. just because your general amount of dorsiflexion improves doesn’t mean your feet still won’t turn outwards when you squat. This is another reason why the screening tests are trash.
Ultimately, if we wanted to ace the arbitrary test discussed in the beginning of this article we’d simply have the lifter squat more to get strong and then practice the test. Since the test is not predictive of anything there’s no reason to obtain the result without gaming the test and further, wouldn’t it be nice to get strong and train productively at the same time?
Do you have any exercises or drills that an athlete can supplement in their program to assist with this issue?
Let’s say we have a lifter whose feet turn outwards egregiously during the descent of their squat at any width, toe angle, heel height, bar position, or squat style. What should they — the population whom I have not ever seen having coached thousands how to squat — do to remedy this?
They should squat anyway. I know…I know. What the hell, right?
See, the thing is that if someone can’t squat without assistance, then they’re incapable of living an independent life and that’s a real problem. If their feet turn outwards when they squat, who cares? Now, if they have pain when they squat that’s a different deal entirely.
One important point to make — one that requires a whole different article — is that we need to divorce the idea of pain and injury. Just because there is damage to some tissue, e.g. a torn meniscus, labrum in the shoulder or hip, or herniated disc doesn’t mean someone is going to have pain. Similarly, the absence of structural damage doesn’t guarantee that someone won’t have pain either.
To go one step further, what even is an injury? If one has proof via medical imaging (x ray, MRI, CT scan) that there is tissue damage somewhere, which occurs in a large amount of the population who do not have any symptoms, is that an injury? Is the presence of pain enough to diagnose injury? Really, it’s sort of a philosophical question because pain is so complex, but I digress.
The theoretical “basket case” of an individual whose feet continue to turn out needs to squat. He will get better at squatting with dedicated practice and his mobility to squat will improve by squatting better than anything else he could be doing with his time.
So, I would just have them squat. If pain occurs that is unresponsive to counseling and there are no red flag symptoms of acute injury requiring immediate intervention, i.e. dislocation, ruptured tendon/ligament/muscle, entrapped nerve, or vascular emergency — then I’d have the athlete leg press, box squat above parallel, lunge, split squat, or just deadlift all while practicing the squat in a manner that does not cause pain. Finally, if none of those things were suitable, I’d have the person perform isometrics without any joint movement until the circumstances change.
Feature image from @jordan_barbellmedicine Instagram page.