Working with Tibial Torsion

I just returned from teaching an intensive course at TCU after a 2-year hiatus, due to the pandemic. It was WONDERFUL to be back teaching in person… even with a mask. This course starts with individual assessments before delving into essential anatomy. Love love love teaching it!

Anyways, there were quite a few students with tibial torsion who didn’t know they had tibial torsion… but were aware of always being told to get their knees over their feet! They were aware that parallel was challenging because during demi pliés, their knees felt like they were going to knock into each other. In first position, they had to pull their knees out over their feet, and were often also lifting up their arches as they were doing so.

The students began to understand that they needed to focus in 2 places, their feet and their hips, to work with their tibial torsion.

They began to monitor the weight on the feet, noticing whether or not it was even between the 3 points of the feet. (The heel, pad of the big toe, pad of the little toe) When the knees are being pulled out over the feet you will notice the weight shifting to the outside of the foot.

They need to temporarily reduce their external rotation at the hip while they work to turn on the turnout muscles appropriately. It is a common pattern to underutilize the rotators on the side with more tibial torsion.

Some of them found that they caught themselves pronating the foot on the side with less tibial torsion. (Monitoring the weight on the feet is always a good idea!)

As they got better with monitoring their hips and feet, their pelvis was better aligned. Why? Because an anteriorly tipped pelvis often goes hand in hand with underutilizing the rotators (and hip extensors) If the pelvis is slightly tipped forward it is easier to turn out the feet without straining the knees.


Tibial torsion doesn’t have to get in the way of being an exquisite technician as long as students are smart about how they work with it. In fact – having the extra external rotation makes their first position look extra sweet, and won’t get in the way, as long as they work the rotators appropriately.

Tibial torsion often is created during growth spurts when the student is turning their feet out more than what they can accurately and efficiently create at the hips. The tibia responds to the force by rotating. It is SO common to see one leg with more tibial torsion and it almost always connects with less access to proper turnout at that same hip. While the student can’t un-rotate that bone, they can correct the way they are using their turnout.

It’s so rewarding to teach students about how their body works. I watched the lightbulbs go off – as they connected their patterns with their technique and their teachers’ corrections. When they shared their insights I clapped my hands in delight and had a huge grin on my face. It’s the best feeling – as I’m sure my fellow teachers would agree!

Below is a clip talking about tibial torsion from some years ago (I miss my dark dark hair:)


External Tibial Torsion
5 replies
  1. Diane Daniel
    Diane Daniel says:

    I found your website from a Google search on external tibia torsion and ballet. I had previously suspected that mine was caused by being put on pointe shoes too early in my physical development, as a was late bloomer. However, your explanation about tibial torsion makes sense for what probably happened to me.

    Your response to another comment about the effect of tibial torsion upon the sartorious muscle has me wondering whether the psoas can be affected, as well. I’ve had periodic trouble with mine off and on for a couple of decades. I’m 61 now. The pain was badly misdiagnosed (endometriosis–in a 50 year old woman!), before a massage therapist figured out that the pain was from my psoas. Now, physical therapy clears it up fairly quickly whenever it flares up.

    I was a ballet and modern dance student at TCU in the late 1970’s. I sure wish that we had had your assessments back then!

    • deborah
      deborah says:

      Hi Diane,
      Welcome to the site! You sound like you are a person who likes to put the pieces and parts together just like me:) Quite possible that the psoas could be influenced from the postural changes that could have been made in response to how one uses turnout, etc.


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