Do I Have Over-Pronation

Overview

Excessive pronation hampers our natural walking pattern, causing an imbalance and leading to wear and tear in other parts of the body, with every step we take! Whether you have a true flat foot or suffer from over-pronation in both cases your poor walking pattern may contribute to a range of different complaints. Especially with age, poor alignment of the feet will cause very common conditions such as heel pain or knee Pain.Over-Pronation

Causes

Overpronation often occurs in people with flat feet, whose plantar fascia ligament is too flexible or too long, and therefore unable to properly support the longitudinal arch of the foot. People tend to inherit the foot structure that leads to overpronation. In a normal foot the bones are arranged so that two arches are formed, the longitudinal and the transverse. Ligaments hold all the bones in their correct positions, and tendons attach muscles to bones. If the bones are held together too loosely, they will tend to move inwards as this is the easiest direction for them to go. Over time the soft tissue structures will adjust to the misalignment and the foot will become permanently over-flexible, with a flat arch.

Symptoms

With over pronation, sufferers are most likely to experience pain through the arch of the foot. A lack of stability is also a common complaint. Over pronation also causes the foot to turn outward during movement at the ankle, causing sufferers to walk along the inner portion of the foot. This not only can deliver serious pain through the heel and ankle, but it can also be the cause of pain in the knees or lower back as well. This condition also causes the arch to sink which places stress on the bones, ligaments, and tendons throughout the foot. This may yield other common conditions of foot pain such as plantar fasciitis and heel spurs.

Diagnosis

Firstly, look at your feet in standing, have you got a clear arch on the inside of the foot? If there is not an arch and the innermost part of the sole touches the floor, then your feet are over-pronated. Secondly, look at your running shoes. If they are worn on the inside of the sole in particular, then pronation may be a problem for you. Thirdly, try the wet foot test. Wet your feet and walk along a section of paving and look at the footprints you leave. A normal foot will leave a print of the heel, connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot, shown opposite. The best way to determine if you over pronate is to visit a podiatrist or similar who can do a full gait analysis on a treadmill or using forceplates measuring exactly the forces and angles of the foot whilst running. It is not only the amount of over pronation which is important but the timing of it during the gait cycle as well that needs to be assessed.Pronation

Non Surgical Treatment

When you see the doctor, he or she will likely perform a complete examination of your feet and watch you walk. The doctor will need to take x-rays to determine the cause of your flat feet. In some cases, further imaging may be needed, especially if your symptoms are severe and sudden in nature. Once you are properly diagnosed, your doctor will create an appropriate treatment plan. There are several options to correct overpronation, such as orthotics. In many cases, overpronation can be treated with non-surgical methods and over-the-counter orthotics. In severe cases, however, custom-made orthotics may work better. Orthotics provide arch support and therefore prevent collapse of the arch with weight bearing. They are made of materials such as spongy rubber or hard plastic. Your doctor will also want to examine your footwear to ensure they fit properly and offer enough medial support. Extra support and stability can be achieved with footwear that has a firm heel counter. If you are experiencing pain, you should be able to use over-the-counter pain medications such as ibuprofen to relieve symptoms.

Surgical Treatment

Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.

An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.

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