What is pronation?

 

What is pronation?

 

Pronation is a movement of the foot which occurs naturally in everyone. It refers to how the foot moves from side to side as we walk or run. It occurs as the weight transfers from the heel to the ball of the foot as a person moves.

 

The joints of our body move in three different body planes and the amount and direction varies greatly between individuals. As a result, people pronate in different ways. Some will see lowering of the arch, others will see the back of the heel turn outwards and others may see the toes splay outwards. In some people, they may only see one of these signs to varying levels (i.e. different arch heights) and others may see a combination of all of these signs.

 

Pronation is not necessarily a bad thing and as a result we tend to talk about normal (some signs of pronation), pronated and highly pronated feet (i.e. more of the signs are present) rather than over pronation.

 

Although flat feet have many of the features of pronation and are generally at the end of the highly pronated feet scale, it is slightly different. Most people have a degree of arch which is often higher when sitting or standing on tip toes and lower when standing and walking.

 

A true flat foot is when all of the bones of the foot are in contact with the floor. If there is a flat foot but the arch rises a little on sitting or standing on tip toes, then this is called a flexible flat foot. If the arch does not change at all, this is called a rigid flat foot.

 

Rare and severe breakdown of the foot and collapse of the arch can be caused by a neuroarthropathy disease process, like diabetic charcot foot.

 

Supination is the opposite to pronation whereby the foot moves in the opposite direction and tends to have a higher arch, with the heel turned inwards and the toes pointing towards the other foot. Even people with a supinated foot can have a degree of pronation but it is very small and the foot tend to be stiffer (i.e. less motion)

 

What are the causes of pronation?

 

Hopefully, you will now understand that pronation is normal and having a highly pronated foot is just a variation with which we were born. This can vary between different racial groups. However, the muscles, tendons, ligaments and bones of the foot are designed to control the forces placed on the foot to allow us to walk and run comfortably.

 

There are a number of factors that can increase the force placed on the foot which means we have to work harder to resist those forces. Simply having tight calf muscles can increase the pressure on the foot and the ball of the foot in particular. Recent research suggests several injuries throughout the body can actually stem from having weak hips. A weak/weaker gluteus medius may increase the forces due to pronation on the foot.

 

As the whole lower limb is involved, this can cause an altered gait and place more stress to the knees, hips and lower back. Wear and tear over time, obesity, pregnancy, injury or hereditary factors can all increase the load on the foot.

 

Take a look at the soles of your shoes.  If the inside of your soles are more worn than the outside, this could be a sign that there is more force on the foot and may provide the first clue that pronation may be part of your problem.

 

Addressing all of the contributing factors will be important which may include specific exercises. However, by adding orthotic insoles to your shoes, you can reduce the load on the foot and help the natural support mechanisms.

 

Common conditions that can be exacerbated by pronation include:

 

•  Hammertoes

– A deformity of the second, third or fourth toes. The toe is bent at the middle joint, so that it resembles a hammer. In the early stages, hammertoes are flexible and can be helped by some simple measures but, if left untreated, they can become fixed and require surgery.

 

•  Corns and calluses:

– These are thick, hardened layers of skin that develop when the skin tries to protect itself against friction or pressure.

 

•  Heel spurs

– Small, bony growths on the heel which may develop when the ligament that connects the heel bone to the bones in the toes pulls on the heel bone. People with heel spurs may not be aware of any symptoms.

 

•  Plantar fasciitis

– One of the most common causes of heel pain which involves overload or degeneration of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes. It most commonly causes stabbing pain that usually occurs with your first steps in the morning.

 

•  Foot/ankle/heel pain

– If you ignore and don’t treat this pain, you may develop chronic problems that require a longer recovery.

 

•  Shin splints

– This is a catch all term but generally refers to a condition called medial tibial stress syndrome; pain along the shin bone or tibia, which is the large bone in the front of your lower leg. They often occur in people who have recently changed their exercise routines.

 

•  Bunions

– This is where the big toe drifts towards the smaller toes and the metatarsal (the main bine that forms a joint with the big toe), drifts in the opposite direction (i.e. towards the other foot). As a result, the joint becomes prominent and may form extra bone/bony lumps. Surgery is the only way to get rid of them. Bunions are usually aggravated by prolonged pressure put on the feet that compresses the big toe and pushes it toward the second toe. Over time, the condition may become painful due the prominence and any extra bone growth.

 

•  Arthritis

– A common condition that causes pain and inflammation in a joint.

 

•  Bone spurs

– Bony projections that develop along bone edges.

 

•  Instability

– Chronic ankle instability is a condition in which the outer portion of the ankle constantly gives way.

 

How do I know if I have pronation and what do I do?

 

If you think you may be suffering from a problem exacerbated by pronation, seek expert help. Your podiatrist will be able to confirm your symptoms and will be able to give you advice on how to manage the factors that contribute to your pronation. They will quite likely recommend that you wear orthotic shoes or insoles.

 

How can you treat pronation?

 

There are several treatments to reduce the effects of pronation, including icing, medication, supportive taping or bracing, physiotherapy or wearing orthotic inserts. Read on for more:

 

Arch support

 

Arch support can help support the foot, reduce either the amount or force of pronation, and create a foundation for the entire skeleton. Arch support is a raised padding or elevation located on the top of insoles in shoes or incorporated into orthotics to help elevate the inside of the midfoot. It is important because pronation may contribute to many problems, such as bunions, hammertoes, tendonitis, fasciitis, back, hip, knee pain, etc.

 

Surgery

 

In more severe cases of flat arch feet, surgery can be an option to bring up the arch or correct the associated problems.

 

Orthotics

 

There are custom molded orthotics made at your podiatrist’s office and over-the-counter versions, like Vionic insoles. Vionic has several styles, including Active, Relief, and Slimfit depending on your specific needs. Flatter feet may need more stability and control and often benefit from a more rigid device to hold up the arch. When pronation is part of the problem, it is important to try and reduce the effect and support the foot. A thicker overall sole is best and preferable to a flat one. It’s about reducing the force caused by pronation and therefore stress to the foot (rolling inward.)

 

Are there any exercises for pronation and ankle pain?

 

While no exercise can reform the arch, it is essential to massage it and do calf stretches. The Achilles tendons (connected to the calf) and the fascia (the major component of the plantar arch) are connected to the heel bone. The fascia also gets stretched and elongated when stretching the Achilles tendon by doing calf stretches. This reduces tightness, soreness, and inflammation.

 

What are the best shoes for pronation?

 

Vionic shoes are designed to provide support and reduce the consequences of pronation, especially for activities such as running or walking. When looking for supportive footwear to help with pronation, you should choose shoes that offer extra support and stability to minimise the impact of each step.

Vionic’s exclusive VIO MOTION™ technology, built into every shoe, is the fusion between dynamic movement and grounded stability, solving whole body balance. Designed with exclusive alignment technology to balance the whole you.

Wearing orthotic shoes or insoles is an easy, effective method of naturally realigning the foot.

 

What happens if pronation is not treated?

 

Many people do not need to have any treatment as this is a normal part of walking. However, if you suffer from a range of conditions such as heel pain, achilles tendonitis, posterior tibial tendonitis, shin splints, tired feet, ankle sprains, bunions, plantar fasciitis, hammertoes, metatarsalgia, unstable ankles and even knee, hip, and lower back pain, this may not get better until you provide the necessary support your foot requires.