Pronation of foot, its complications and solutions
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What exactly is the foot pronation?
This is the movement which occurs at Subtalar joint - between the talus and calcaneus.
Generally there are two movements which occur at Subtalar joint:
a. Inversion (the movement that allows you to walk on the side of your foot) and
b. Eversion (the opposite of inversion) movements.
Functionally when standing, pronation (eversion) occurs as the foot rolls inwards and the arch of the foot flattens. Pronation is a normal part of the walking/running which helps to provide shock absorption at the foot.
The opposite movement to pronation is supination (inversion) in which the movement that allows you to walk on the side of your foot. This is also a normal part of the gait cycle but sometime it can be excessive which is called oversupination
Overpronation?
The pronation when it is excessive, here the term overpronation (or hyper-pronation) is used. This is quite a common problem in lots of patients and can lead to a number of injuries, especially in runners, jumpers, sprinters and the sports which requires frequent running and turning.
In Overpronation the affected foot is rolling in. This causes the lower leg to turn inwards which puts the knee and hip out of alignment and can cause the back to be rotated and which is the reason the over pronation of foot affects the entire segment of lower body.
When the foot is gets corrected with an orthotic device. This inserts into the running shoe and controls the position of the heel allowing the rest of the foot to fall into place and allow the entire segment of lower body to move into proper plane..
Complications and injuries which causes by Overpronation:
Overpronation usually causes over-use syndrome types of injuries. When a neutral foot pronates during walking or running, the lower leg, knee and thigh all rotate internally and when an athlete with an overpronated foot runs, this rotation movement is exaggerated and becomes more marked.
Excessive pronation always causes excess stress on the inner surface of the foot cause injury and pain in the foot and ankle. Repeated rotational forces through the shin, knee, thigh and pelvis also place additional strain on the muscles, tendons and ligaments of the lower leg.
Including:
- Shin splints
- Anterior compartment syndrome
- Patello-femoral pain syndrome (Petellar Tendinitis)
- Plantar fasciitis
- Tarsal tunnel syndrome
- Bunions (Hallux valgus)
- Achilles tendonitis
- Piriformis syndrome
- Iliotibial band syndrome
- Hallux Abducto Valgus (bunions)
- Hallux Rigidus (stiff 1st toe)
- Arch Pain
- Metatarsalgia (ball of the foot pain)
- Ankle sprains
- Osteochondrosis
- Knee Pain
- Corns & Calluses
- Flat Feet
- Hammer Toes
How Can I tell if I Overpronate?
a. Observation:
Look at your feet in standing; have you got a clear arch on the inside of the foot? If there is not an arch and the innermost part of the sole touches the floor, then your feet are overpronated.
b. Wear and tear around shoes:
Look at your running shoes. If they are worn on the inside of the sole in particular, then pronation may be a problem for you
c. Wet foot test:
Wet your feet and walk along a section of paving and look at the footprints you leave. A normal foot will leave a print of the heel, connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you’re feet are pronated there may be little distinction between the rear and forefoot, shown opposite
Diagnosis:
Get a gait analysis (Observation Gait Analysis / Video Gait Analysis) done of your running style, this will highlight if you have overpronation or oversupination or have a neutral arch.
Nowadays there are lots of new technology which has come which will help you understand what your normal distribution of force around ankle is whether you are putting force on your ankle equally, deviating other side, force is falling forward or backward from normal plane, line of gravity shifting shifting away from center of base of support. There is such technology which called “I-Step” which can be uses to evaluate distribution of force..
Solutions:
a. Running shoe
If you find you are overpronating, get a running shoe with extra medial support. Many running shoes have a harder material on the inside of the midsole (the thick hard foam part of the running shoe). This means the inside of the shoe will be compressed less under load and support the inside of the foot preventing it from rolling in or flattening.
b. Orthotic/Insoles (Arch supports):
Based of Examination and conclusions, Finding of observation through Observation Gait Analysis / Video Gait Analysis and distribution of force, there are newer technology (for e.g. Amfit) which can be use to design customized insole keeping proper arch support, heel control and met pad support which has been always proves to give maximum supports and comfort to foot and shoes in static as well as in dynamic postures and movements..
For people with considerable overpronation, another option is to have an orthotic device fitted. Orthotic insoles come in many types and prices. Some are pre-molded and can be bought off the shelf.
There are some cases which require especially casted/custom made orthotics/insoles from a relevant sports injury therapist or podiatrist.
Treatment/Rehabilitation:
Treatment and rehabilitation is purely based on patient’s response, sign and symptoms, examination and diagnosis...
Treatment includes for correction of over pronation along with correct running shoe and orthotic prescriptions are:
- Soft tissue release for the over acting muscle if there is any lump or tightness, especially muscle and soft tissue around plantar aspect, ankle and leg region. E.g. calf muscle, plantar fascia, dorsiflexors (front leg muscles), invertors and evertors (lateral and medial leg muscles) and intrinsic foot muscles.
- Flexibility (Stretching) for the tight soft tissues or muscle around ankle, plantar region and leg region. E.g. calf muscle, anterior leg muscles, plantar fascia and intrinsic foot muscles.
- Strengthening Exercises with elastic resistance bands or weight for muscles of entire lower body. E.g.
§ Dorsiflexors (Front leg muscles)
§ Plantarflexors or calf muscles (Back leg muscles)
§ Evertors (outer leg muscles)
§ Invertors (inner leg muscles)
§ Intrinsic foot muscles (muscles of the sole of the foot).
§ Quadriceps (front thigh), hamstring (back thigh), adductors (inner thigh) and abductors (outer thigh) muscles.
§ Back muscle, hip muscles, and core muscles.
- Ankle Stability training on wobble board or stability trainer.
- Ankles taping to off load the pressure from affected area.
Home remedy:
The home remedies are proven to be a great way to relieve pain from home. If you combine them with a treatment such as stretching the calf against the wall, you'll likely increase your treatment success.
- Calf stretch against the wall: stand facing the wall with knee straight and place the heel close to the wall with toes pointing upwards with the heel in contact with the floor. Bring the heel as close as towards the wall toes pointing upwards and the bring your hip forward towards the wall and feel the stretch. Put your stretch in mild discomfort range and hold for the 15 – 20 seconds, repeat that for 3 - 4 times.
- Wall stretch for calf muscles (Method one): Stretching both the calf muscle and soleus muscle will prevent tightness along the achilles tendon and into the feet. This variation on the wall stretch targets the soleus muscle.
For this type of exercise you place the both feet together, placing both hands on the wall in front of you for support.
Keeping your feet forward with both feet together, take one foot and place it about 5-6 inches from the original position to the front.
Evenly distribute your weight on both feet, and slowly squat down about 7-9 inches, leaving your heels on the ground. Squat down to a very mild discomfortable position that can be held for 15-20 seconds, and where a good stretch along the backs of the heels and calf muscles can be felt. Come back to neutral position and repeat on the other leg.
- Wall Stretch for calf muscles (Method two): Another variation on the wall stretch to treat plantar fasciitis, heel pain and Achilles tendonitis.
For this type of exercise you will start with both feet together, placing both hands on the wall in front of you for support.
Take a large step forward with your toes about 1-2 inches away from the wall. Shift your weight onto the front leg and bend at the knee, keeping the back leg straight and both heels on the ground. Using the wall for support, lean forward into the wall and feel the stretch along the back leg and calf. Hold this stretch 15- 20 seconds in very mild discomfort range and repeating 3 times. It will loosen tight calves which are a major contributing factor to heel pain and plantar fasciitis.
Return to a neutral position and repeat on the other side. Be sure to keep the back leg straight and the front knee in a bend.
- Calf Muscle Stretch with Belt: Take a wide belt and hold one end in each hand. Place the center of the belt over the ball of the foot. With your knee straight, pull your ankle back toward you using the belt and the muscle on the front of your leg. Reverse stretching your arch. Pull back and hold for 15 - 20 seconds. Relax and repeat 3 - 5 times.
- Heel Pain Stretch: Place your hands on a wall in front of you while placing one foot in front of the other. Keeping both your heel flat on the ground, bend your knees so that you can feel the lower part of the leg stretch. Hold this position for about 15 seconds and repeat this stretch several times.
This exercise is useful in stretching the lower leg, particularly the muscles in the calf and the Achilles tendon. By doing this, it can release tension not only in the lower leg, but also tension and stress placed on the plantar fascia.
- Plantar Stretch: A great stretch to lengthen the plantar fascia ligament and prevent morning pain is plantar stretch. This stretch is designed to treat and prevent heel pain and plantar fasciitis and when done in the morning alleviates morning pain.
Start with both feet in front of you and bend one leg at the knee. Grab the ball of the foot with one hand over the toes and pull towards your chest. By pulling the ball of the foot and not the just the toes this will create a good stretch along the arch of the foot.
Stretching the plantar fascia ligament will aid in the treatment of plantar fasciitis by developing length in the ligament. Stretch the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. Stretching will alleviate tension along the plantar fascia ligament and prevent the soft tissues of the foot from tightening up.
Hold this stretch on each foot for 15-20 seconds and repeating on both sides 3 times, once a day, improvement should be seen within 1 week of consistent stretching!
- Morning Exercises for Heel Pain & Plantar Fasciitis: you will need is a belt or towel next to your bed.
Starting the first of three exercises, sit up with your legs straight out in front of you. point and flex your toes to get the muscles warmed up. Slowly point your toes as far down as you can, then flex them back up, warming up the muscles and soft tissues for the next exercise. Repeat 10 times.
The next exercise is the belt stretch which can be performed with a belt, scarf or towel.
Sitting with your feet out in front of you, wrap the belt around the ball of one foot, grabbing the belt with one hand on each side of your leg. Sit up as straight as possible and use your arm strength to pull the ball of the foot into a flexed position without using your foot strength to do so. Hold for 20-30 seconds and repeat on the other side. Make sure that the towel or belt is wrapped around the ball of the foot and not just the toes, this will ensure a better stretch for the plantar fascia ligament.
After you have performed the point and flex warm up and the belt stretch, massage the plantar fascia ligament. Massaging the plantar fascia ligament across the width of the plantar fascia. Starting at the inner side of the arch, massage across the width to the outside of the arch, with a light amount of pressure to ease your ligament to be prepared for your body weight when you get out of bed.
The micro tears in the plantar fascia cause inflammation and pain. Due to these micro tears the ligament tightens up during the night and with your first step, causes pain. By massaging and stretching you can prevent re-injury to the plantar fascia ligament each morning along with reducing your pain. A night splint is also recommended for treatment of morning pain.
