Ossie Garriott

Foot Problems In Older People

Is Over-Pronation

Overview

Pronation is the inward movement of the foot as it rolls to distribute the force of impact of the ground as you run. The foot "rolls" inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. Pronation is critical to proper shock absorption, and it helps you push off evenly from the front of the foot. Although pronation is a natural movement of the foot, the size of the arch can affect its ability to roll, causing either supination (underpronation) or overpronation. If you have a normal arch, you're likely a normal pronator, meaning you'll do best in a shoe that offers moderate pronation control. People with flat feet normally overpronate, so they do well in a motion-control shoe that controls pronation. High-arched people typically underpronate, so they do best in a neutral-cushioned shoe that encourages a more natural foot motion.Overpronation

Causes

It is important to identify the cause of overpronation in order to determine the best treatment methods to adopt. Not all treatments and preventative measures will work equally well for everyone, and there may be a little trial and error involved to get the best treatment. A trip to a podiatrist or a sports therapist will help you to establish the cause of overpronation, and they will be able to tell you the best treatments based on your specific degree of overpronation and the cause. Overpronation has many causes, with the most common reasons for excessive pronation listed, low arches, flexible flat feet, fallen arches, gait abnormalities, abnormal bone structure, abnormal musculature, bunions, corns and calluses.

Symptoms

Over-Pronation may cause pain in the heel of the foot, the foot arch, under the ball of the foot, in the ankle, knee, hip or back. The symptoms may be localized to one particular area of the foot or may be experienced in any number of combinations. Standing for long periods of time, walking and running may become difficult due to the additional stress and/or discomfort accompanied with these activities. Upon Visual Inspection, when standing the heels of the foot lean inward and one or both of the knee caps may turn inward.

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.Over Pronation

Non Surgical Treatment

Orthotics are medical devices used to provide support to correct a physical abnormality. They can provide arch support when needed to remedy over-pronation, and in this particular cases the orthoses used are usually convenient shoe inserts. These can be taken in and out of shoes, and will be carefully tailored by your podiatrist to the specifics of your foot. It can take some weeks before the effects of the inserts can become truly noticeable, and in many cases your podiatrist will want to review your orthotics within a few weeks to make fine adjustments based on how well they have worked to reduce your pain.

Surgical Treatment

Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
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