During weight bearing, what is the initial compensation for fixed forefoot valgus?

• A. Rearfoot supination
• B. Rearfoot pronation
• C. Medial (internal) tibial rotation
• D. Ankle dorsiflexion

Answer: (A)

When weight is borne, the body first uses the hindfoot to adjust for forefoot valgus. If the forefoot is fixed and tilted outward, the initial response is rearfoot supination (inversion). This inward turning of the heel helps align the foot on the ground, raises the medial arch, and brings the forefoot into a more stable contact pattern despite the forefoot’s fixed valgus. Pronation of the hindfoot would worsen the misalignment, ankle dorsiflexion doesn’t address the forefoot-hindfoot relationship in this scenario, and tibial internal rotation tends to occur after the foot has started to pronate. Therefore, rearfoot supination is the first, most effective compensation.