Orthotics and Over Pronation

Experienced runners are usually all too familiar with the accompanying aches and pains that develop in the feet, knees, hips and/or the lower back. Runners often experience the following conditions:

  • 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
  • piriformis syndrome

And these are just the most common conditions that runners may develop over the course of their career over the period of time that they are running recreationally.

Physical activity is good for the body but it also causes a lot of wear and tear as well, but poor biomechanical functioning in the body is one of the most important factors in developing these conditions, especially if sub-par or detrimental functioning is occurring in the feet or ankle. Malfunctioning in either of these areas leads to an increased chance of developing inflammation and pain.

When we walk our run our body mass gives our forward motion momentum and pushes us into a ‘falling forward’ position. It is our front foot hitting the ground and the motion of our back leg swinging forward that prevents the fall from occurring. This cycle of movement is repeated with each step.

When our foot makes contact with the ground its first job is to absorb and minimize the impact of landing, followed by a pronation of the foot as it accommodates the contour of the landing surface. Our ankles then flex in order to allow for a forward motion of the knee, with our body following behind. Then our heel raises off the ground and our foot supinates, creating leverage to help with the necessary ‘push’ forward that results in the toes pushing off of the ground. This is a simplified version of events designed to give you a basic understanding of the complicated mechanics involved during the walking and running process.

Runners are often told that they have developed problems due to over-pronation after having gait-analysis performed by a trainer or coach, or by personnel working in running shops. This usually results in the runner being fitted with standard orthotics, custom orthotics, or stability shoes in an attempt to prevent over-pronation of their feet from occurring. And while these kinds of treatments are often effective they are not always the proper action to take when a runner’s foot appears to be over-pronating, as improper use of devices can treat one problem while creating another.

Proper and through evaluation procedures must be used to ensure that flawed treatments are not used and that modifying footwear or introducing orthotic devices is not prematurely prescribed, and there is good reason for this level of caution:

When normal movement occurs in the foot and ankle 15-20 degrees of ankle dorsiflexion occurs as well as 60-65 degrees of extension in the big toe (when the toe bends backwards). Pronation and supination are normal functions of the foot during the moving cycle; our feet are required to do this for proper functioning and to minimize the force of impact. It also creates the leverage need for forward motion.

It is not pronation that is blamed for the above the complaints, but “excessive pronation”, which is when the foot stays in pronation for longer than the ideal amount of time. It is this “excessive pronation” that is targeted for correction, but it is often incorrectly applied. All too often people go to a doctor or a specialty store in pain and are given a cursory once-over and then measured for a shoe or orthotic device. More of than the not the initial complaint is addressed…but then a new complaint arises because something else begins to hurt even though your training has remained the same.

It shouldn’t be a coin toss whether a shoe or orthotic is used to correct for over-pronation; the decision should be based on a close and detailed examination of the foot and the gait when walking. It also means that there should be an examination of the hip, pelvis, knee, ankle and foot. Various range of motion movements should be performed including a lunge and squat test in order to get a better sense of your force production and dissipation, stability, proprioception, and balance levels.

It’s important that your leg length is measured so than inequalities can be found or ruled out, and it must be determined whether the pelvis and spine are capable of proper movement of the joints and correct alignment. Also, the length and strength ratio of your muscles needs to be evaluated. If these different aspects of corporeal function are not examined it is very easy to make an incorrect diagnosis and apply an incorrect treatment, which lead to further pain and dysfunction in the future.

Incomplete range of motion in the ankle joint is one of the most common causes of overpronation; if your foot and/or ankle cannot bend backward correctly then your knee will not move forward enough to get your body’s center of mass of your feet, which means that your body will be struggling to execute a forward motion.

When this lack of bending occurs in the ankle the foot is forced into excessive pronation which causes the knee out of alignment. When the knee is forced out of alignment it forces the hips out of alignment as well as they try to adjust to this unnatural movement. This is, of course, the beginning of a very dangerous chain reaction that affects the all of the mechanics in the body.

Reduced ankle mobility is common but cannot be treated with shoes or orthotic devices. These types of treatments often cause problems in and of themselves because in this instance overpronation occurs as one part of the body tries to compensate for the inflexibility of another part of the body. If you remove the compensating movement without fixing the underlying cause you are interfering with the body’s natural protective mechanism and simply forcing the compensating movement to occur elsewhere in the body. You are not actually fixing the problem.

There is a very simple test that will help you determine if flexibility and mobility issues are an underlying cause that you must address:

  • Stand with your feet shoulder-width apart.
  • Look down; verify that your feet and toes are pointing forward and not out to the sides, away from your belly button.
  • Try to squat low enough that your knees bend at 90 degrees or lower of flexion without your heels rising off of the floor or your feet turning outward.

If you cannot correctly perform this exercise then it is likely that you are experiencing overpronation in your feet because of inflexible ankles, and that is the issue you will have to address rather than the pronating foot. But it’s also important to remember that there are other factors that could be relevant and other issues occurring that were not covered in this article.

It’s always best to consult a professional and have a full structural and functional examination and evaluation performed before you try to correct foot pronation. If you skip this important step if may cost you both time and money if you invest in inappropriate treatments and/or devices such as shoes or orthotics. At the end of the day the most revealing question is not if you overpronate, but why.