There’s No Single Solution for Pronated Feet
Overpronation is too much of a good thing. Pronation is a natural movement of the foot and ankle that occurs in healthy humans when we walk and run that helps absorb the shock of your foot striking the ground.
Pronation is a combination of 3 movements:
3) Forefoot abduction
Overpronation is when too much of these movements occur, which can lead to repetitive stress injuries and pain because if you’re overpronating, you’re putting excess stress on medial ankle and medial knee tissues.
Some of the issues that can crop up as a result of overpronation include:
Achiles tendonitis: in fact, a 2017 study showed that achilles tendon blood flow was decreased in overpronators, which can lead to impaired tissue recovery and pain. 
Plantar fasciitis: this 2014 study from the Journal of Biomechanics shows that overpronation results in greater stress to the plantar fascia. 
Shin splints: also known as medial tibial stress syndrome, overpronation and a pronated foot posture showed strong evidence as a risk factor as outlined in this 2014 study. 
Patellofemoral pain syndrome: the same shin splints study also linked overpronation to PFPS.
As you can see, overpronation can result in a number of different issues.
So if you get knee pain and you have overpronation but your treatment only includes glute, quad and hamstring exercises and stretches, you’re missing a critical component of your rehab.
How to Correct Overpronation
In today’s video, we’re going to explore some of the root causes that can lead to overpronation in the first place, that must be addressed to correct the problem at the source.
These 3 causes are by no means comprehensive as the human body can compensate in creative ways to get around dysfunctions you have.
If you’re an overpronator, I hope this gives you more insight into the issue and gets you thinking about how to fix it.
One exercise that I love that’s a part of my Lower Limb Control course is the Seated 4-Way MTP Slide.
While the technique looks simple, there are a few important cues that must be followed to make it effective.
Check it out here:
This is a great technique to do when you’re at the office or sitting around at home. If you can’t slide your foot, no worries, just get to end range where you can keep your foot flat and apply metatarsal pressure and you’ll still benefit. But it is definitely done best on surface where you can slide your foot while applying metatarsal pressure the whole time.
Are You Suffering from Collapsed Foot Arches?
As OrthoFeet strives to share information with you about foot ailments, we’ve more than once raised the point that your feet support your entire body. When it comes to your feet, nothing should be taken lightly or for granted.
A very common biomechanical phenomenon is Flat Feet, or Over-Pronation, which occurs during standing or walking, when a person’s arch collapses upon weight bearing.
There are many conditions that can cause flat feet and over-pronation. Common foot deformities and flexible muscle structure are the most frequent causes. The structure of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot.
Other conditions including obesity, pregnancy or repetitive pounding on a hard surface, can weaken the arch and lead to over-pronation.
Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves. Over-pronation often leads to plantar fasciitis, heel spurs, metatarsalgia, tendonitis and/or bunions. In some cases over-pronation can affect your knees, hips and even lower back because when the foot pronates (flattens) it causes the leg to internally rotate, resulting in improper posture of the entire leg and back.
Treatment and Prevention
Over-Pronation can be treated conservatively with orthotic insoles that are designed with appropriate arch support to prevent the over-pronation. Stability shoes that feature a firm heel counter and wide soles help reduce over-pronation, as well.
Take a look at OrthoFeet shoes that are specifically constructed to support flat feet and over-pronation at https://www.orthofeet.com/collections/flat-feet-shoes
- Strengthen your foot muscles through toe curls, heel raises, and other exercises to improve foot support, stability and shock absorption.
- Do not walk barefoot – Always wear proper fitting and supportive shoes
- Avoid running or other high-impact sports
If you still experience foot pain, and your quality of life is affected by over-pronation you should seek the help of a podiatrist.
The shape of the human foot and its mechanics are designed to minimize the stress of walking or running. When your foot pushes off, it propels you forward by rolling outward or supinating. When it strikes the ground again, it absorbs the shock of impact by rolling inward or pronating.
This process is normal and healthy. In fact, it’s crucial to protect your joints over the long haul. But when your foot rolls inward a little too much, that’s when you can start to have problems. This is called overpronation, and it’s the leading cause of most runners’ injuries.
Overpronation can destabilize your body when walking and running
Your foot continues to roll inward even after it’s made its landing. What happens next depends on the structure of your feet, ankles, and calves, but many runners experience nasty stress injuries:
Overpronation can also play a role in acute injuries, like ankle sprains.
Are you an overpronator?
Overpronation isn’t always obvious. Most people take the way that they walk or run for granted. You can always have your gait analyzed by a foot and ankle specialist, but there are some ways to tell at home.
First, overpronators typically have flat feet, and extremely flexible arches. That excessive movement makes it hard for your body to support your weight while running.
Wet foot test
You can check this using the wet foot test. Dip just the sole of your foot into a pan of water. Be careful not to soak the entire foot and arch – just the bottom!
Next, step onto a newspaper or paper bag. If your footprint leaves you asking, “what arches?” then you’re probably an overpronator.
Wear and tear on your shoes
You can also tell from the wear and tear on your shoes. Flip your running shoes over. If the heel and ball of the foot leading into the big toe are all worn in, then overpronation is the likely culprit.
How to correct for overpronation
So, you’re an overpronator? Don’t worry; you’re in good company! Livestrong.com estimates that 20-30% of runners are severe overpronators, while up to 60% are mild overpronators. Keep reading to learn how to reduce your risk of injury.
To keep your arches from collapsing with every step, you need sturdy, supportive footwear. Shoes with proper arch support will keep your foot in alignment and give you stability. Avoid any shoes with flexible soles, especially trendy “minimalist” shoes.
Even if you get brand new, motion-controlling shoes, they may not be enough to correct the effects of overpronation. That’s why our doctors can’t recommend this next solution highly enough.
Our patients LOVE their custom orthotic insoles. They’re specially fitted to your feet and tailored for your activity purposes. Insoles can both treat current injuries – like plantar fasciitis – and prevent new injuries from occurring.
According to a 2017 study published in the Journal of Biomechanics, custom insoles minimized the angle of pronation at ground strike and raised the height of the arch. “When feet are supported in correct alignment, also the position of the knees, pelvis, and hips are corrected, thereby providing a solid foundation for the entire body,” writes lead author Dr. J. Kosonen.
Forget the soft and foamy models you find at the drugstore. “What overpronators really need is structure,” said Dr. Bob Baravarian, “I’d recommend a semi-flexible plastic at a minimum, which can then be covered with a cushion for comfort.”
Tips to help pronate like the pros
Can’t afford new shoes or insoles at the moment? No sweat! There are steps you can take (see what we did there?) to reduce the impact of overpronation while you’re running.
Focus on your stride
Improving your form can help mitigate discomfort and prevent future injuries. Taking short, quick steps instead of long, drawn-out strides can minimize the foot’s rotation, and decrease your chances of over-striding.
You can also employ stretching and strengthening exercises (really, if you’re not already stretching after your runs, then you’re just asking for a stress injury).
Try some of these easy stretches that take five minutes or less.
Calf raises. Stand with your feet shoulder-width apart, toes pointed forward. Slowly, lift your heels off the ground and lower them back down. Repeat 10 times. You can even try these on one foot at a time.
Ball roll. Massage the arches of your feet with a golf ball or a frozen water bottle. Repeat with each foot for one minute.
Point, flex, curl. Sit on the floor with your legs straight out in front. Point the toes, then flex them back. Finish with a toe curl. Repeat this 10-12 times.
If you are experiencing problems with your feet or ankles we are here to help. Our nationally recognized podiatrists and foot and ankle specialists offer the most advanced foot and ankle care along with the highest success rates in the nation. We are leaders in the field of research and treatment of all foot and ankle conditions.
For more information or to schedule a consultation, please call (877) 736-6001 or visit us at www.footankleinstitute.com.
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Dr. Avanti Redkar is board certified in podiatric medicine and joined University Foot and Ankle Institute under a fellowship in sports medicine and ankle reconstruction. She attended podiatry school at the New York College of Podiatric Medicine and went on to complete her surgical residency at Good Samaritan Hospital in West Islip, New York, where she was trained in foot and rearfoot surgery, wound care, and hyperbaric medicine.
Dr. Redkar specializes in foot and ankle pathology and is available for consult at our Mid-Wilshire Los Angeles and Beverly Hills locations.
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Pronation refers to the process that occurs when our feet hit the ground when we walk or run. Normally, our feet hit the ground in a specific way. First, the heel touches the ground. Our body weight then shifts towards the middle of the foot and the arch of the foot flattens a bit. Pronation is the medical name given to the flattening process. If the arch does not flatten or flattens too much, pronation problems occur. This can cause pain and other issues in the feet and ankles, including in some cases a bending of the ankle bone towards the center line.
Pronation and Ankle Problems
A condition called over-pronation occurs when the arch of the foot flattens inwards too much as you walk. This over-pronation may be caused by genetics, injury, improper gait when walking or running, over-exertion or wearing improper shoes. This over-pronation can cause the ankles to bend slightly inwards as you walk. This can lead to ankle pain. Although it effects and creates symptoms in the ankle, the problem with the foot is the underlying cause.
Flat Feet and Ankle Problems
A condition called “flat foot” is often a cause of these ankle problems. Flat feet are a normal condition in children who are just beginning to walk; however, if the arch does not sufficiently develop as children grow, a condition called flat foot develops. The foot does not pronate properly, and ankle problems become persistent or exacerbated. Adult flat foot, if left untreated, can give rise to a condition called tibialis posterior tendinitis, which results in persistent pain in the foot, the heel and sometimes the ankle.
Pronation problems are diagnosed by a doctor who observes your feet as you walk. A doctor may also examine your shoes for signs of abnormal wear and tear that suggest a pronation problem. Examining the ankle may or may not be necessary, depending on whether the flat foot is actually affected the ankle bones or whether the pronation problems are simply causing pain in the ankle as a symptom of the issues with the foot.
The most common treatment for ankle over-pronation is the use of orthotics to correct the improper arch of the foot. Physical therapy may also be recommended, and NSAIDs (non-steroidal anti-inflammatory medicines, including some common pain killers) may be prescribed to deal with ankle pain that results from pronation problems. Taping or a brace of the foot or ankle may also be recommended. In rare cases, a surgical operation may be performed to adjust the shape of the midfoot bones to correct flat foot or to correct torn or damaged tendons in the foot caused by the flat foot or over-pronation.
Unfortunately, most ankle over-pronation can’t be prevented because the underlying cause of the condition–the improper gait–can’t be prevented. However, wearing orthotics in your shoes to correct the pronation problem can resolve the ankle pain and prevent the ankle bones from becoming injured.
- Cho Foot and Ankle Specialists
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- Foot Care Associates
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In this post, you’ll learn how to fix flat feet using corrective exercise and self-myofascial release and how to correct the feet-ankle pronation dysfunctions.
If you’re wondering if it’s possible to correct flat feet using exercise, I hope this post will give you all the info you need to accomplish that.
Please note, there may be other underlying causes of flat feet not covered in this post. Always check with your physician to ensure the issue can be addressed using corrective exercise.
And, if anything isn’t clear, don’t hesitate to leave me a comment at the end of the post.
What This Post WIll Help You With:
- Basic Anatomy of the foot arch
- Pronated vs normal ankle
- Postural and movement issues stemming from flat feet
- How to fix flat feet and restore the arch with exercise
- Video tutorial on how to do that
- My thoughts on arch supports
If you have flat feet or notice your feet turning inwards during certain exercises or when walking, make sure to follow the steps in this post to fix this imbalance because it can cause multiple other dysfunctions further up the body’s joints system.
The body is a connected kinetic chain.
Issues at the bottom (base) can have an effect on all the other joints and muscular systems up the kinetic chain.
This is why ankle dysfunctions quickly affect the knees. And, knee issues can cause hip issues as well.
Basic Anatomy Of The Foot And Ankle
The feet are considered the foundation from which we derive our base of support.
The body and the ground connect at the feet.
The feet sustain the ground reaction force. It’s an area of high importance that we can’t ignore to heal joint or muscle pain anywhere in the body.
In addition, imbalances related to this area can influence every other area of the body.
The medial longitudinal arch is composed of the first metatarsal, medial cuneiform, talus, navicular, and the calcaneus.
The Plantar Fascia is a band of tissue that connects the calcaneus to the metatarsal heads to support the longitudinal arch.
Pronated vs Normal Ankle Joint
As the ankle starts to pronate and evert, the tibia (calf bone) starts to come inwards as well, driving the knee to internally rotate.
Postural And Movement Issues Originating From Flat Feet
Unfortunately, flat feet can affect both your posture and movement patterns. Here’s how…
… Flattening of the feet (feet pronation) leads to knee valgus or internal rotation of the knee when engaging in certain exercises like squatting or simply walking (1).
You probably notice this imbalance among people (or perhaps yourself too).
Tightness of the lateral gastrocnemius, soleus, and peroneal muscles can contribute to flattening of the feet and internal knee rotation.
Imagine these muscles shortening, and pulling the outside of the leg out while the internal area is pronating.
As the lateral side tightens, the medial side (inside the foot) is pulled inwards into pronation.
I’ll show you how to release these muscles in a minute. As well as how to strengthen the opposing muscles that pull the foot into supination.
The goal is to restore muscle balance.
If you notice that certain exercises, such as the squat, exacerbate this imbalance and bring your knees together further, that is a good indication of tight calf muscles.
The muscles that are weak and should be strengthened are the medial gastrocnemius, posterior and anterior tibialis.
Strengthening the gluteus medius and gluteus maximus will also play a huge role in corrective the squatting movement and avoiding knee internal rotation.
As the glute med will keep the hip leveled and help stop the internal rotation of the knee.
How To Fix Flat Feet And Correct Pronation Imbalance.
Full disclosure: this post contains affiliate links. I only mention products I personally use and recommend…and if you purchase from Amazon using my affiliate link, I get a small commission. You won’t pay more!
Below is a step-by-step tutorial on how to perform self-myofascial release.
I’ll explain how to release the tight calves muscles. And, how to activate the anterior and posterior tibialis and medial hamstring with one exercise.
Grab a foam roller. This is the one I use from Trigger Point brand. And these are the resistance loop bands that I use.
Additional Supportive Tools
Corrective exercise can help you fix flat feet and restore the foot arch.
You can certainly use arch supports as well. But make sure you’re not relying on any device alone.
Devices can help, but in the long-term, they can further weaken stabilizing muscles. Your muscles simply get weaker because there is no need for them to work anymore.
Many women use waist trainers to try to lose belly fat. Wearing a waist trainer for hours weakens the deep core musculature and can lead to lower back pain.
In addition, you’re not even breathing properly from your belly as the belt is pulling the belly in.
Any device will have an effect on the body in the long-run. Always weigh the cost and effects of these added devices on the body before committing to using them for the long-term.
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Choosing the best shoes for pronation involves assessing your level of pronation to gauge how much support is required. Manufacturers usually rate their shoes as suitable for mild, moderate, or severe pronation, so it’s important to know how much you overpronate. Shoes for pronation should provide a high level of support and contain firm insoles. Perhaps best way to ensure that you purchase the right running shoes is to get them professionally fitted. Other considerations include which type of terrain you run on and whether you have orthotics.
A normal foot is said to have a neutral arch. If you overpronate, however, your foot arch is lower than it should be. This puts the kinetic chain of the lower body out of alignment, and can cause serious problems, especially during high impact activities such as running. The best shoes for pronation help to support the foot arch and realign the ankle, knee, and hip.
To realign the foot and leg, shoes for pronation need to provide extra support and stability. Motion control shoes, which are rigid, durable and built to control pronation, are often the best type for severe overpronation. If you only have mild pronation, then a stability shoe may be enough to keep the arch from collapsing too much while running. A runner who over pronates usually should avoid shoes that have a lot of cushioning.
As with any shoe, it’s important to ensure that shoes for pronation are correctly fitted. Buying from a professional running shop is important for this reason. Shoe sizes measure the length of the shoe, but it’s also necessary to get the right width. If you wear orthotic inserts to correct for overpronation, then it’s mandatory to wear these while the shoe is fitted.
There are two main types of running shoe: trail and road. If you plan on trail running, it’s important to buy durable shoes for pronation that are built for this purpose. A trail running shoe will provide more grip and often extra protection from rocks and roots. Road running shoes tend to require greater shock absorption to protect the joints.
If you use orthotics, it’s important to purchase a shoe that will work in conjunction with them. In some cases, using highly supportive shoes and supportive orthotics can prevent the foot from pronating enough. For this reason, you should discuss the options with a podiatrist before choosing a pair of shoes for pronation.
This duck footed position if you will, is a sign of an imbalance in your hip extensor or glutes. This can be a result of various factors, but can be easily addressed using a few soft tissue techniques.
One reason this can be a major factor in injury is because of the knee angle it will most likely cause. This will be particularly important when partaking in sport, whether it be running, weight lifting or roller derby.
It is something that is taught in the upper level athletes called knee valgus.
When standing in this position you create a shearing force in the knee joint. This causes force to cave in the knees.
You begin to lose power in this position because the force that is being transmitted down your kinetic chain is dispersed through the valgus knees. Instead of driving the force straight down into the knees it is converted to shearing force, force coming from the outside of the knee in.
Ideally in all sports and positions you want your knees to align directly with your feet. You want your toes and your knees to point in the same direction, as shown in the next picture.
This is going to be the position you can create the most power in. When you are in the position of the first picture (knee valgus) the force is dispersed through the knees. Your knees therefore absorb the leaded force. This could be dangerous and lead to ligament tears in the knee joint. In the second picture when everything is in line you can then create force from the hips, the powerhouse, that travel down the kinetic chain.
It is a long and complex process to correct this knee valgus problem, retraining the motor control system.
Collapsed ankes could also be helping to cause this problem. This is another reason why it is important to have a proper ankle stability and mobility routine in your strength training program. Check out this guide for a few strengthening exercises.
What I am addressing in this post is externally rotated feet. We will leave the topic of knee valgus for another post.
The primary culprit of this position is the glute muscles. When these muscles begin to hold tension you naturally externally rotate, beginning from the hip joint, causing turned out feet.
What we will work on is mobilizing using soft tissue and some static stretches. Part 1 of this post will focus on soft tissue, part 2 will be the static stretching
Also it is going to take effort to consciously be aware and not allow yourself to go back into this position.
First I will list the tools needed to execute these soft tissue mobilization exercises.
LACROSSE BALL, ORB, PVC PIPE, FOAM ROLLER
We will begin with soft tissue work on the glute. It will depend on your experience and the level of tension in your glute on which tool to begin with.
If you are a beginner, a foam roller will work just fine. If you have experience, then you may want to use the soft ball or Orb. If you have used both of those you then can graduate to a more specific, or evil (depending on who you are talking to) tool, the lacrosse ball.
The first variation is to position yourself with one glute on the roller. Make sure to get the whole glute. It?s common to stop too low. You want to roll out the whole length of this muscle. When you find an exceptionally tight area you can focus your efforts there a little extra. It is optimal to roll out for 2 minutes on each side.
The second variation is going to be crossing your leg. This is going to lengthen the muscle in order to get a little deeper in the tissue. Once again when you run into an extra tight area feel free to focus your efforts there.
The third method is what’s called tack and floss. You will be in the same position as the last picture but you will begin to move your leg (the side that is on the roller or ball) back and forth.
What is happening here is the layers of tissue are starting to slide over each other. This is going to help break up those adhesions that lie deep within the muscle belly.
Overpronation of the feet occurs when the inner arch of the foot drops down and inwards. It is commonly related to excessive tightness of the calf muscles. Severe overpronation oftens results in a Flatfoot deformity.
Due to the abnormal mechanics, pain may result over the medial ankle (Posterior Tibial Tendon hence the other name PTTD or Posterior Tibial Tendon Dysfunction Syndrome), Plantar Fasciitis and Arch pain, as well as possibly leading to Bunion formation.
Overpronation is usually treated non operatively with Orthotics from a Podiatrist. While most men are quite happy to use them, ladies are less keen as they cannot be used with sandals and open footwear.
Failure of treatment with Orthotics previously used to mean complicated foot surgery with long recovery times. Fortunately we now have several minimal access surgical (MAS) options with shorted recovery times. This has revolutionized treatment of mobile flatfeet.
A mobile flat foot is one in which the arch is passively correctable during examination. This accounts for the vast majority of patients with flat feet. The root cause of the foot problem is actually in the tight calf. In many cases there is no abnormality in the foot itself. It is this group of patients who are suitable for these new MAS techniques.
In all these patients, it is essential to examine for the tight calf. In most of these , the tightness must be addressed at surgery as it is the root cause of the problem. Fortunately, it is easily remedied by a MAS technique known as a Gastroc(nemus) Proximal Release.
This procedure is low risk and the patient can walk immediately after the surgery. No cast is needed. By 5-7 days the patient is more or less walking normally.
The second part of the correction is the use of a Subtalar Stent. This Minimally Invasive Procedure involves the placement of a small Titanium piece of metal that prevents the foot from overpronating. Done one side at a time, the patient can also walk immediately, but will take about 3-4 weeks to be comfortable. Return to running will take about 6-8 weeks.
Together, this combination of MAS procedures ie the Gastroc Release and the Subtalar Stent is able to correct many of these patients. Some pateints however, may require additional procedures depending on the severity of the problem.