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1st May

2010

Pronated Feet

Today I will write about pronated feet, and how this at times may contribute to a variety of musculoskeletal injuries or painful conditions.

DYNAMIC VERSUS STATIC PRONATION

Pronation of the foot is the action where joints in the foot move in a certain way so that the arch of the foot sinks down during weightbearing. This is a normal component of foot mechanics while walking. However, some people have prolonged or excessive pronation, which can lead to problems. It is important to differentiate between static pronation, or simply put “flat feet” which is present whether or not the foot is weightbearing, and dynamic pronation, where the arch is well restored when not weightbearing, but is diminished when weight is put on the leg. The over pronators who most commonly develop problems, are those with dynamic pronation.

OVER PRONATED FEET LACK STABILITY

When the foot is pronated, it allows for maximal mobility of joints in the mid-and forefoot. When the foot first comes in contact with the ground, and we shift our weight over the foot, pronation acts as a shock absorption, or torque conversion mechanism, allowing for a smooth and efficient step. However, in order to effectively propel ourselves forward as we prepare to push off on the foot, the foot needs stability for muscles to act on, which normally occurs as the foot supinates, or the arch of the foot is restored. The foot which remains excessively pronated or for too long during the gait cycle, lacks this mechanism, which can lead to unwanted consequences and compensatory actions throughout the leg.

COMMON CONDITIONS SEEN WITH OVER PRONATION

The most common problems associated with over pronated feet that we see in physical therapy are plantar fasciitis (pain in the arch and bottom of the heel), chronic mid-foot ligament laxity and pain, shin splints, patello-femoral pain (pain in front of the knee), lower leg (tibia) stress fractures in runners, and for some even hip and lower back pain. Uncorrected long-term, excessive foot pronation can lead to bunion formations and hallux valgus of the big toe (toe points inward towards other toes) and joint pain with mobility restrictions in the big toe, which in turn can severely affect the foot mechanics even more.

COMMON CAUSES

Many people with over pronated feet have congenital or developmental deviations in the position of their rear foot (heel) when standing, or forefoot when not weightbearing. Commonly, these people stand with the heel tilted so the inside of the ankle falls in and down, and/or their forefoot is tilted in relation to the ankle when the weight is off the foot, with the big toe side of the forefoot being angled up (forefoot varus). Both conditions tend to exaggerate the foot pronation when walking or running. Other people may have tight calf muscles (gastrocnemius most common), have weak muscles which can pull the arch up, or have congenital “bowing” of the lower leg bones or other lower extremity angulations.

HELPFUL TREATMENT

Mentioned mechanical foot deviations can often be effectively treated with custom foot orthoses, or “orthotics”, to position the foot in a more normal fashion during weightbearing. We prefer to make plaster impressions of the feet without weight on the foot, and with the foot and ankle kept in a favored neutral position. We then send the casts with a specific measurement prescription to a podiatric laboratory, which then fabricates the orthotics of choice, as per our prescription.

Many people could also benefit from specific exercises aimed at restoring a more normal arch with weightbearing. People who have developed various secondary conditions in part due to the foot over pronation, also usually need specific treatment to decrease such pain.

Finally, it is important to wear proper shoes, whether for walking, or for running or other specific sports. The choice of shoes may also depend on whether or not custom orthotics are made for the person. Minor hyper pronators can often be helped, at least partially, by getting “stability” running shoes, some with a firmer inside wedge in the sole by the heel, and by wearing an insert such as “Superfeet”. However, for others this is insufficient.

With best wishes for a healthy spring,

Gunnar

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