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.
There are many possible causes for overpronation, but researchers have not yet determined one underlying cause. Hintermann states, Compensatory overpronation may occur for anatomical reasons, such as
a tibia vara of 10 degrees or more, forefoot varus, leg length discrepancy, ligamentous laxity, or because of muscular weakness or tightness in the gastrocnemius and soleus muscles. Pronation can be
influenced by sources outside of the body as well. Shoes have been shown to significantly influence pronation. Hintermann states that the same person can have different amounts of pronation just by
using different running shoes. It is easily possible that the maximal ankle joint eversion movement is 31 degrees for one and 12 degrees for another running shoe.
It is important to note that pronation is not wrong or bad for you. In fact, our feet need to pronate and supinate to achieve proper gait. Pronation (rolling inwards) absorbs shock and supination
(rolling outwards) propels our feet forward. It is our body?s natural shock-absorbing mechanism. The problem is over-pronation i.e. the pronation movement goes too deep and lasts for too long, which
hinders the foot from recovering and supinating. With every step, excess pronation impedes your natural walking pattern, causing an imbalance in the body and consequent excessive wear and tear in
joints, muscles and ligaments. Some common complaints associated with over-pronation include Heel Pain (Plantar Fasciitis) ,Ball of foot pain, Achilles Tendonitis, Shin splints, Knee Pain, Lower Back
When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation
changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking
barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.
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.
Calcaneal "Slide" (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive
option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.