Overview
Normal, healthy feet pronate! Normal pronation does not need to be ?corrected?. However, some people OVER-pronate. Those people need a shoe that supports their over-pronating foot to help guide the foot and avoid injury. So, what does pronation mean exactly? Well, ?pronate? is the word used to describe the natural motion of the foot after it strikes the ground. When a person with a normally pronating foot runs, the outside part of the heel strikes the ground. As the individual shifts the body weight forward, the foot rolls inward (pronates) and the entire foot comes into contact with the ground. This allows the foot to properly support the body and absorb the impact forces. Motion continues forward and the peron pushes off (called ?toe off?) evenly from the front of the foot. Someone who OVER-pronates strikes the ground with the heel in the same way, but the foot rolls too far inward (overpronation). This causes foot and ankle strain, as it does not allow the foot and ankle to properly support the body nor to properly absorb the impact forces. As motion continues forward, they will toe-off more from the ball of her foot. Runners who overpronate are susceptible to foot, ankle and knee problems if they don’t wear a shoe that properly supports the motion of their feet.
Causes
Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he or she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.
Symptoms
Overpronation may have secondary effects on the lower legs, such as increased rotation of the tibia, which may result in lower leg or knee problems. Overpronation is usually associated with many overuse injuries in running including medial tibial stress syndrome, or shin splints, and knee pain Individuals with injuries typically have pronation movement that is about two to four degrees greater than that of those with no injuries. Between 40% and 50% of runners who overpronate do not have overuse injuries. This suggests that although pronation may have an effect on certain injuries, it is not the only factor influencing their development.
Diagnosis
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
Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot. If the problem persists, call your doctor to schedule an appointment.
Surgical Treatment
The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
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