Good morning. Happy Monday. I have no coffee in hand and it is perfect. Coming off a strong weekend, a little bit of housekeeping. IFAST members, we have a call at 1 p.m. Eastern Standard Time today, so please join us for that. If you are not an IFASTuniversity.com member, please go to IFASTuniversity.com. Get yourself signed up. Join us at 1 p.m. Eastern Standard Time. These are awesome calls. A lot of good stuff going on there. Digging into today's Q&A, this is with Taya. Taya had what she thought was a very simple foundational question in regards to knee varus and valgus. I don't like to use those terms too much because they imply that the frontal plane exists and I think as we all know by now it does not. These are not straight plane problems. These are orientations in rotation and so we always remember that we're going to end up starting with some form of rotation. It's typically going to be femur turning inward relative to the tibia. That's how all of this is going to get initiated and then it's just progress from there. So keep that in mind as you go through this Q&A today. We're going to talk a little bit about how this evolves and a little bit about solutions, and I think it's going to be helpful for a lot of people because again, there's still a lot of confusion in regards to this knee presentation. So thank you, Taya. If you would like to participate in a 15-minute consultation, please go to askbillhartman at gmail.com, put '15 minute consultation' in the subject line so I don't delete it. We will arrange that at our mutual convenience. Everybody have an outstanding Monday and I'll see you tomorrow.

Hi, sir.

You can call me Bill.

Bill. So formal. Well, with the complexity of the questions popping up, I'm going to take it back to simple. I want to ask about the knee, Valgus and varus presentations.

So formal.

With the complexity of the questions popping up, I'm going to take it back to simple. I want to ask about the knee, valgus and various presentations.

So the knee, what?

Velgas and various. Oh, yeah, yeah, yeah. I know, like I can picture and imagine what's going on in the knee. I just have a hard time picturing the reasons they occur. Why do they occur? And how do they affect the foot mechanics?

Lateral, medial, understand? Okay. Which one, what do I have to do to make a valgus knee?

In turn, I rotate the femur and tibia into external tissue.

There you go. Problem solved. Awesome. What do I have to do to make a varus?

Just the opposite.

No. Oh. Nice try, though.

I would have to internally retain the TVA.

Okay. So here's what's going to happen.

You see it? Hang on. Let me get real close. Varus.

You see what it did? So, valgus. Watch. Varus.

You just magnified the internal rotation of the femur.

No. What I did is I superimposed more external rotation on the entire leg. So let me back up. Varus, or I'm sorry, valgus. Got it? Valgus. Varus. Okay.

So would you say that the Valgus would be something that happens before the Varus position or?

I would say that you have femoral internal rotation on the tibia prior to the superposition of more external rotation that creates the Varus representation.

Okay.

We've been talking about, let's go back to Grace's question. Remember how we were talking about if you put more pressure around the outside of the foot, you lose more relative motion? Yes. So when you get your center of gravity pushed way forward, your center of gravity moves up and forward. So that's moving up and out. Valgus turns everything down and in. So when you get really extreme valgus knee people, their arches are really low. And then you get the really extreme varus people and their arches are really high.

Yeah.

And then you get the really extreme varus people and their arches are really high. So if I push the center of gravity forward and it goes down and in, I'm gonna get a valgus representation at the knee most often. If I keep pushing that forward, they have to start to externally rotate again to move their axial skeleton between their feet and it turns it back outward. So that's the difference. So the representation at the knee is the same. What happens is you get more external rotation on a varus looking knee than you do on the valgus looking knee. There's just more external rotation.

So would you say that someone with the varus presentation of the knee is pushed more forward than the one with the valgus?

That is correct. Yeah. That's exactly what I would say. But it also tells you what you need to do from a sequencing standpoint. So if I have somebody that's pushed farther forward and they have more external rotation superimposed, I have to reduce that first, then I can worry about the knee. If you go chasing the knee too soon, you might make symptomatic changes; you might get lucky, but the reality is, more often than not, I have to reduce that extra little bit of external rotation that got superimposed first, okay? Then I can go after the knee because I know what the knee orientation is probably going to be because there's only a few options available to me.

Yeah.

Do you understand that there's no valgus or varus?

Yeah, I understand. I just didn't know how to differently describe the presentations.