Pronation occurs as weight is transferred from the heel to the forefoot and the foot rolls inwards. Or to put it a little more technically; pronation is the movement of the subtalar joint (between
the talus and calcaneus) into eversion, dorsi flexion and abduction (turning the sole outwards, upwards and sideways). A certain amount of this is natural but it many people the foot rolls in too
much or over pronates.
Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness,
ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of
the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak,
the muscle cannot adequately slow the natural pronation cycle.
Because pronation is a twisting of the foot, all of the muscles and tendons which run from the leg and ankle into the foot will be twisted. In over-pronation, resulting laxity of the soft tissue
structures of the foot and loosened joints cause the bones of the feet shift. When this occurs, the muscles which attach to these bones must also shift, or twist, in order to attach to these bones.
The strongest and most important muscles that attach to our foot bones come from our lower leg. So, as these muscles course down the leg and across the ankle, they must twist to maintain their proper
attachments in the foot. Injuries due to poor biomechanics and twisting of these muscles due to over-pronation include: shin splints, Achilles Tendonitis, generalized tendonitis, fatigue, muscle
aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). Foot problems due to over-pronation include: bunions, heel spurs, plantar
fasciitis, fallen and painful arches, hammer toes, and calluses.
Bunions, calluses and crooked toes may indicate alignment problems. So, it is important to ascertain the condition of a client's toes. Check the big toe to determine if the first joint of the toe is
swollen, has a callus or bunion, and/or looks as though it abducts (i.e., hallux valgus) rather than pointing straight ahead. Also, look to see if the lesser toes seem to "curl up" (i.e., the person
has hammer or claw toes). This may be indicative of damage to, or inflexibility of the plantar fascia caused by excessive flattening of the foot.
Non Surgical Treatment
If a young child is diagnosed with overpronation braces and custom orthotics can be, conjunction with strengthening and stretching exercises, to realign the bones of the foot. These treatments may
have to continue until the child has stopped growing, and orthotics may need to be worn for life in order to prevent the foot reverting to an overpronated state. Wearing shoes that properly support
the foot, particularly the arch, is one of the most effective treatments for overpronation. Custom-made orthotic inserts can also be very beneficial. They too support the arch and distribute body
weight correctly throughout the foot. Motion-control shoes that prohibit pronation can be worn, so may be useful for those with severe overpronation. One good treatment is to walk barefoot as often
as possible. Not relying on shoes to support the arch will encourage proper muscle use. Practicing yoga can help to correct poor posture and teach you how to stand with your weight balanced evenly
across the whole foot.
Many of the prevention methods for overpronation orthotics, for example, can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a
podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also
talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can
sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and