The term "pronation" refers to the normal rotational movement of the ankles and the slight flattening of the plantar arches that occur when walking and running. A little pronation is essential (the ideal is a 15% flexion at the ankles), because it allows you to distribute the force of the impact during walking or running; basically, its function is to absorb the shock from impact with the ground. However, when pronation is excessive (called "overpronation" in this case), it can lead to collapse of the arches (flat feet), creating problems in the ankles, knees, hips and lower back. For this reason it is important to know your degree of pronation, in order to choose the appropriate footwear and / or corrective insoles.
Steps
Method 1 of 2: Determine Overpronation at Home
Step 1. Check the shoe soles
When walking normally (gait), the heel lightly hits the ground with its outer or lateral edge; this is why shoes are often more worn in this spot. If the soles of your shoes seem particularly worn in the central heel area or, worse, on the inner or middle edge of the rear sole, it means that you tend to have excessive pronation when walking.
- It's easier to notice the type of wear on old rubber-soled running shoes because they wear out faster.
- If you notice excessive wear of the footwear on the outer (lateral) edges of the back of the sole, it could be a sign of a complete loss of normal pronation and excessive stiffness in the ankles and / or arches; this disorder is called hypersupination.
- Those who suffer from overpronation are generally not great sprinters, because the ankles and feet cannot transmit sufficient propulsive force to the legs.
Step 2. Find the space under the foot
When standing upright (standing), there should be enough space between the ground and the inside of the sole of the foot to insert a toe without too much effort or discomfort. Then ask your partner or friend to help you and insert the index finger under the central area of the sole of the foot, while standing on a solid floor; if it is able to insert it without difficulty and without creating discomfort, it means that you have a normal arch and do not have overpronation (at least when you are in a standing position). Otherwise, if your friend doesn't have enough space to easily slip his toe under his foot, you probably have flat feet; this is the main indicator and possible cause (or even effect) of overpronation.
- It is best to do this type of test with bare feet and standing upright on a solid floor, such as parquet, tile or linoleum.
- Having normal-looking arches when standing is not always a guarantee of proper pronation while walking. When the plantar arch is too stiff it cannot collapse, but the ankle joint can still rotate inward and over pronate when walking or running, although this is quite rare.
- Likewise, even having flat feet when standing does not necessarily mean that you are over pronating.
Step 3. Wet your feet and walk on a cardboard
A good objective test that helps to understand if you are overpronating or not and / or if you have flat feet is precisely that of "wet feet". Wet the soles of your feet with a little water and walk over a cardboard, thick paper, or a surface where you can clearly see your footprints. Make sure you leave both footprints and observe them carefully. A foot with a healthy arch and normal pronation leaves the heel imprint that connects to the forefoot thanks to a strip that is half the width of the foot and stretches out on the outside. If you have overpronation you should see the footprint of the entire sole of the foot, as it makes full contact with the floor as you walk or run. This phenomenon is abnormal.
- The appearance of the footprints of the arches in this type of test is a good indicator of foot pronation, but it does not automatically mean that you have overpronation, because many people with flat feet do not always have this defect when they walk.
- Usually, both feet leave the same type of footprint, but in some cases there are differences due to previous foot / ankle injuries or limbs of different lengths.
Step 4. Check your posture in the mirror
Another way to understand how your feet and ankles work during movement or in an upright position is to observe the posture you assume (especially in the lower body) when standing in front of a full-length mirror. Put on some shorts and observe your legs, knees and ankles. Typically, people with their knees very close to each other or who touch each other in a standing position (called "valgus knees" or "X-knees") tend to suffer from over pronation and flat feet, because there is more pressure in the medial part. of the foot. Also, look at the thick tendon that connects the heel with the calf muscle, called the Achilles tendon. It should be straight, but if there is over pronation, it is almost always crooked and bent sideways.
- Overpronation is sometimes associated with genetic factors that determine the development of the ankles and feet, but is often due to obesity. Overweight people can suffer from posterior tibial tendon dysfunction (DTTP); the arch of the foot is largely supported by this tendon, which can wear out when subjected to excessive strain.
- When looking at your posture in the mirror, your legs should be fairly straight, with at least a few inches of space between the knees. People who have "bow legs" (the medical term is "varus knee") often tend to put more weight on the outside of their feet, leading to hypersupination.
Method 2 of 2: Get a Medical Evaluation
Step 1. Contact your family doctor
If you think you have significant overpronation and are concerned that it may be causing pain or other symptoms in your feet, ankles, knees, or lower back, make an appointment with your doctor. Although he is not a podiatrist (who specializes in treating the lower extremities), he is still able to evaluate the normal anatomy and physical appearance of the feet and to determine if there are any abnormalities, so that he can give you qualified advice. It can also better determine the cause of your symptoms. For example, pain in the feet, ankles and / or knees is often caused by osteoarthritis (due to wear and tear), repetitive trauma, circulatory problems, lack of physical activity, obesity and has nothing to do with the degree of pronation.
- Your doctor may recommend an x-ray of your feet; this is the best technique to observe the alignment of the bones (for example it is possible to see a possible collapse of the ankle joint), but it is not able to highlight the integrity of the ligaments and tendons that form the plantar arch.
- He may also advise you to lose weight by changing your diet to relieve symptoms and reduce the degree of pronation in your feet.
- If you are pregnant, she will advise you to be patient, because the hormones that are released during pregnancy make the ligaments looser, resulting in temporary overpronation and flat feet. Sometimes, this can become a lifelong ailment; if your symptoms last more than six months after giving birth, you need to get checked again.
Step 2. Consult a podiatrist
This is the foot specialist who has the most knowledge and expertise about the normal biomechanics of the lower extremities and the disorders or problems that cause abnormal gait (when walking or running), including over pronation and flat feet. He will be able to examine your feet, including the arches and ankles, to determine if your degree of pronation is normal or needs to be corrected. Often the podiatrist performs a computerized gait analysis to better define your walking style and pronation level. Typically, the exam involves walking on a pressure-sensitive platform connected to a computer. Some doctors also use thermography (you will need to walk on heat-sensitive mats) to better understand the biomechanics of the feet during movement.
- Some diseases that lead to chronic over pronation are plantar fasciitis, heel spur, bursitis, Achilles tendonitis, and tibial medial stress syndrome.
- To correct over-pronation, podiatrists typically recommend custom orthotics (inserts in shoes that provide sturdy arch support) or custom-made orthopedic footwear to try to prevent the ankles from rotating excessively.
- Podiatrists are also qualified to perform minor foot operations, although more complex or invasive procedures must be performed by orthopedic surgeons.
Step 3. Get advice from an orthopedic surgeon
If you are concerned about over pronation (with or without flat feet) and have not gotten adequate relief from various conservative solutions, such as orthotics, supportive shoes, and even weight loss, you should ask your GP to refer you to an orthopedic surgeon (which deals with musculoskeletal injuries) specialized in the feet. The specialist may undergo a computed tomography, MRI, or diagnostic ultrasound to examine the soft tissue in your feet, determine if pronation is excessive, and determine the cause. He is able to tell you if you suffer from this disorder and describe all possible treatments, including surgical correction of the defect. In any case, he will most likely not recommend the operating room until he has tried all other solutions without success.
- Some causes of excessive pronation, such as tarsal coalition (an abnormal fusion of two or more bones around the ankle), can only be corrected with a surgical procedure.
- Sometimes surgery is also done to stretch a too tight Achilles tendon or to repair the posterior tibial tendon (the main arch tendon of the foot) that is too loose; both of these disorders cause over pronation.
- Recovery time from surgery depends on the type of procedure performed (whether it is necessary to break or fuse bones, sever tendons, or modify ligaments), but it can generally take several months.
Advice
- If your case of overpronation is mild or moderate, look for stable footwear that has a dual-density midsole and offers several points of support along the sole of the foot.
- If you suffer from severe overpronation, look for shoes that control movement and have more stable support devices inside.
- If you have hypersupination (other than overpronation) look for footwear with neutral padding and a soft midsole, which promotes greater pronation.
