Overpronation and Insoles

If you run for long enough you will likely become familiar with the discomfort that can occur in the feet, knees, hips and the lower back. Serious runners must often deal with the following conditions:

  • Plantar fasciitis
  • Achilles tendinitis
  •  Iliotibial band syndrome
  • Tears to the miniscus
  • Patellofemoral pain syndrome (runner’s knee)
  • Bursitis in the knee and/or hip
  • Chondromalacia patella (affects the knee)
  • Lower back pain
  • Piriformis syndrome

Although there are several other conditions that may develop over time these are the afflictions most commonly experienced by runners.

Physical activity does the body good but it also causes a lot of wear and tear to occur in the muscles and joints. The biggest danger by far, however, is sub-par or inferior biomechanical functioning in the body, especially in the lower regions, such as the ankles or feet. Inferior functioning in either of these areas leads to an increased risk of inflammation and injury.

Oddly enough, it is during the two most common activities—walking and running—when we can incur the most damage to our lower regions. When we are moving forward our body mass provides momentum and causes us to ‘fall forward’ but our front foot hits the ground and our back leg swings forward and counteracts this momentum so that we remain upright.

Our feet are designed to absorb the shock of impact when our foot strikes the ground, and then pronate inward to adjust to the ground surface. Our ankles are designed to then flex, which allows our knees to move forward over the toes with our bodies following close behind. At this point the heel lifts from the ground, and leverage is created as our foot supinates and our toes help to push us off of the terrain.

The entire process is, of course, much more complicated than the rundown given here but this brief description is designed to give only a basic understanding of our mobility process so that we can discuss the issue of overpronation.

One of things that runners often told is that the problems they are experiencing are due to overpronation after a cursory analysis is performed by coaches or consultants who work in specialty running stores. Generally speaking the reflexive response of these trainers and personnel is to fit the runner with an orthotic device or special shoes. And while this quite often solves the problem it is also a dangerous assumption to make, as improper use of orthoses can create secondary problems in the attempt to treat the initial issue.

Because of the risk involved in using orthotic devices to improperly treat overpronation it is necessary to have a thorough examination performed by a specialist and the reason for this level of caution is as follows:

Normal movement in the lower body requires 15-20 degrees of ankle dorsiflexion and 60-65 degrees of flexion in the big toe. Normal movement also requires some degree of pronation and supination in the feet during weight bearing activities so that the force of impact is neutralized and properly absorbed; this combination of inward and outward activity also provides the leverage we need in order to move forward.

Therefore, for precision’s sake we must say that it is excessive pronation that causes injury, and not the regular degree of pronation required for forward movement. For excessive pronation to occur the foot must remain pronated for longer than the usual or necessary amount of time. It is, in fact, excessive pronation that is supposed to be corrected but the means of correcting it are often misguided. It too often happens that injured runners show up at the doctor’s office or specialty store, are asked a few questions and given a brief, generalized examination, and then advised to purchase a special shoe or orthotic insert. It also often happens that the initial complaint is redressed but that a secondary issue soon arises, even when training methods have remained consistent.

It shouldn’t be assumed from cursory gait assessment or a questionnaire that it is the foot that is the primary cause of overpronation; the hip, pelvis, knee, ankle and foot also need to be examined and evaluated. Range of motion tests such as lunges and squat tests should be also be performed so that your stability, proprioception, and balance levels can be determined.

Leg length should also be measured for inequalities and the pelvis and spine must be tested for proper range of motion, joint mobility, and correct alignment. The length and strength ratio of your muscles should also be taken into consideration. If these elements are not assessed and included in the diagnosis then it becomes quite easy to make a false diagnosis and prescribe an inappropriate treatment, and this often leads to more pain and secondary injuries or complaints.

An underlying problem that can cause overpronation in the feet is inadequate range of motion in the ankle joint. When the foot and/or ankle does not have sufficient flexion the proper backward bend cannot be completed, and this will block the knee from moving forward enough to ensure that the body’s center of mass ends up directly over the feet, which results in your body struggling to complete a forward motion.

This particular lack of flexion forces the foot to pronate inward too much and for too long, which first throws the knee out of alignment and then the hip as well. This knee and hip displacement sparks an entire chain of events that can cause pain and injury throughout the body.

While poor ankle flexion is common it can’t be treated with orthoses or specialty footwear. The reason orthotics can cause such intense problems under these circumstances is that overpronation is occurring because the body is using it to compensate for lack of flexibility in the ankle, and if you remove this compensating movement without addressing the actual problem you are disrupting the body’s protective mechanism and moving the compensation elsewhere; hence the secondary issues that frequently develop after orthotic devices are introduced.

 

You can perform a simple test to determine if inflexibility is an underlying issue that needs to be addressed:

  1. Stand straight. Place your feet shoulder-width apart.
  2. Ensure that your feet and toes are pointing forward and not out to the sides.
  3. Squat far enough down that your knees are at 90 degrees or less while making sure that your heels remain on the ground and that your feet do not turn outward.

 

If you cannot perform this exercise with the proper degree of flexion or while keeping your feet and toes forward and your heels on the ground then it’s likely that flexibility issues are causing you to overpronate. You will need to address this issue rather than trying to straighten the feet with orthotic devices. Note: there could be underlying conditions causing overpronation that were not covered in this article, and this is why it’s always best to consult a professional for a full examination before pursuing treatment.

One thing to understand is that finding the true cause of overpronation is much more important than simply knowing that is occurring in the first place.

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