Putting Your Best Foot Forward: Avoiding Foot Pronation
By Dr. Hamid SadriFirst Choice Healthcare
If you have been running long enough, you most likely have had to deal with various aches and pains in your feet, knees, hips, or lower back. Plantar Fasciitis, Achilles tendinitis, IT-Band Syndrome, Meniscus tears, Runner’s Knee, Bursitis of the hip or knee, Patellofermoral pain syndrome, Chondromalacia Patella, lower back pain and Piriformis Syndrome are only some of many conditions an athlete may develop during the course of his or her running exercise. Although there are many factors that can contribute to the development of these conditions, improper biomechanics of the body certainly play a large and detrimental role in the process. Of the many biomechanical elements involved, foot and ankle functions perhaps contribute the most to the presence or absence of these aches and pains.
During the normal process of the gait cycle, the forward movement results from the center of mass being displaced so as to put the body in a “falling forward” position. At this time, the lead foot hits the ground preventing the fall, followed by the rear leg swinging forward and the cycle repeats with each step. Once the foot hits the ground its first function is to absorb and help dissipate the shock of impact. This is followed by pronation of the foot so that it can help accommodate the ground contour; the ankle goes into flexion allowing the knee to move forward and the body follows, the heel rises, the foot supinates and becomes a rigid lever that aids in the pushing action that eventually ends with the toe-off. Many other intricate and complex components of motion mechanics take place during this process, but for our purposes, this helps to explain the basics.
A common element that we come across in our practice on a daily basis is runners who have been told that their particular condition is a result of “over pronation”. In some instances they have had some form of a “postural or gait analysis” done either by a coach, trainer or healthcare professional, or at a running store. They have then either been fitted with stability shoes, off-the-shelf orthotics or costume-made orthotics; the general intention being to prevent the excessive pronation of the foot. Although this is needed in some cases, it should not be done in each and every case when a runner’s foot seems to over pronate. Doing so can and often does result in one symptom going away and another, usually a more complicated one, developing elsewhere. The following is a brief and simplified reasoning as to why this practice may be flawed if a proper evaluation has not been performed prior to modifying shoes or using orthotics.
In a normal functioning ankle and foot there should be 15-20 degrees of ankle dorsiflexion present (leg moving forward on top of the foot; or, same as the foot bending backward toward the leg) as well as 60-65 degrees of 1st toe extension (bending backward). Foot pronation (turning downward or inward) and supination (turning upward or outward) are normal and needed movements for proper function during the gait cycle. All feet must do this and do it well in order to minimize the forces that the body has to deal with during walking or running, and also to create the lever that is needed for propulsion. It is the “excessive pronation” that has been considered a great offender in many of the above referenced conditions. This is when the foot remains in pronation for a longer than normal period of time. This also is what most people try to correct, and often do so improperly.
In order to correctly determine if an over pronation should be corrected using shoes or orthotics, a functional and a structural examination is mandatory. This requires an evaluation of the pelvis, hip, knee, ankle and foot ranges of motion along with at least a lunge and a squat test to examine other elements of motion such as force production, force dissipation, proprioception, stability and balance. Leg lengths must be examined to rule out inequalities. The pelvis and the spine must be evaluated for proper joint motion and alignment. Last but not least, muscle length and strength ratios may need to be assessed. Without these factors being accurately examined, an improper correction will be done, which will eventually result in other dysfunctions and ensuing pain.
One of the common and frequent reasons for over pronation is a lack of normal ankle range of motion. If the foot/ankle is unable to dorsiflex (bend backward) properly, it will not allow the knee to travel forward enough for the body to move its center of mass over the foot, hence making the forward motion of the body difficult. In such a case, the foot is forced to pronate excessively and as a result the knee will drift medially (toward midline) and the hip will have to excessively adduct (move toward midline) and internally (turn inward) rotate. This of course continues into the rest of kinetic chain and results in other abnormalities in motion mechanics. In this particular (and did I say common and frequent) instance of lack of ankle mobility, making a correction through shoes and orthotics is often asking for nothing but trouble. The over pronation in this case is a needed compensation for a lack of mobility elsewhere in the body. Taking this compensatory element away without first addressing and correcting the true underlying cause will inevitably force compensation (frequently accompanied by pain) in another part of the body. How many of you have gone to your favorite therapist, doctor or shoe store complaining of some sort of pain, had a cursory evaluation, were fitted with shoes or orthotics and found that indeed your complaint(s) resolved... but only to find yourself complaining of something else hurting you a few weeks later without having changed anything else in your training?!
Here is a simple way to test and see if you happen to fall under this particular category. While in a standing position, place your feet shoulder-width apart. Make sure that your feet and toes are pointing forward and not turned outward (away from the midline of the body). See if you can get into a squatting position that places your knees at or below 90 degrees of flexion (bending) without your heels coming off the ground or your feet externally rotating (turning outward). If you are unable to complete this test, then there is a good chance that your foot pronation is due to inflexibility of your ankles and that is what should be corrected not the pronating foot. Please note that there are other factors, beyond the scope of this article that can be involved here as well.
In any case, before you consider correcting that foot pronation, be sure to have a detailed and complete structural and functional evaluation done by a qualified provider. Not doing so may cost you much more than an improperly fitted shoe or useless pair of orthotics. Remember that the true question to be answered here is not IF you over pronate, but rather WHY!
Dr. Sadri and his team at First Choice Healthcare have been fanatically caring for our athletes at their Decatur location for several years, and most recently, at The Sport Factory's new Roswell location. He can be reached through his practice at First Choice Healthcare.
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