Pronation describes a slight inward rolling motion the foot makes during a normal walking or running stride. The foot (and ankle) roles slightly inward to accommodate movement. Some people, however,
over-pronate and roll more than normal. With over-pronation, the arch of the foot flattens and causes excessive stress and pressure on the soft tissues of the foot. Over-pronation is more common in
those with flat feet, and can lead to foot aches and pain, such as plantar fasciitis, Shin Splints and Knee Pain.
A common cause of pronation is heredity - we can inherit this biomechanical defect. The second most common cause is due to the way our feet were positioned in the uterus while we were developing;
this is called a congenital defect. In either instance, the following occurs in our feet during our development.
Common conditions seen with overpronation include heel pain or plantar fasciitis, achilles tendonopathy, hallus valgus and or bunions, patellofemoral pain syndrome, Iliotibial band pain syndrome, low
back pain, shin splints, stress fractures in the foot or lower leg.
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you
might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the
ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more
prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and
stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space
where your arch did not touch the ground).
Non Surgical Treatment
The way a foot orthotic works is by altering the weight-bearing surface of the foot. The simulated foot improvement is only possible when standing still with full weight applied. Orthotics are of
little help through most of the actual walking cycle. observationPatients may experience some symptom relief, but the orthotic cannot correct the internal osseous misalignment. Over-the-counter foot
orthotics are usually of little help and wear out quickly. Custom-made foot orthotics, obtained through your doctor's office, are generally expensive. Though they last longer and have less chance of
ill-effects than OTC brands, they still need to be replaced often. Over a lifetime, an individual can spend several thousands of dollars in total costs associated with orthotics and see little or no
results. This is because orthotics only work when you are wearing them and do not treat the cause of the problem. In many cases, the external pressure points created by orthotics can cause more
problems than solutions. Blisters, sore feet, sore joints and many other long-term complications can arise as a consequence of wearing orthotics.
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with
fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.