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.
Flat feet don't automatically mean you have a problem. The problem can be divided into a flexible flat foot or rigid flat foot. The rigid flat foot is one that does not change shape when the foot becomes weight bearing. i.e. it does not go through the excessive motion of pronation. Generally speaking this foot does not provide too many problems. The flexible flat foot is the type that when it becomes weight bearing the foot and ankle tends to roll in (pronates) too far. This type of person will often say I have great arches but when I stand up much of this arch disappears as the foot excessively pronates When the foot is excessively pronating and causing problems like sore ankles, feet or knees when standing or exercising then arch support is extremely important to restore the foot structure.
Because overpronation affects the entire lower leg, many injuries and conditions may develop and eventually cause problems not only in the leg and foot, but also the knee, hips and lower back. Pain often begins in the arch of the foot or the ankle. Blisters may develop on the instep, or on the inside edge of the heels. As overpronation continues and problems develop, pain will be felt elsewhere, depending on the injury.
So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. 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.
Non Surgical Treatment
Solutions typically presented will include physical therapy sessions, prolonged prescription drug regimens, occasionally non-traditional approaches like holistic medicine and acupuncture. These options can provide symptom relief in the short term for some patients. However, these treatment methods cannot correct the internal osseous misalignment. Ligaments are not effective in limiting the motion of the ankle bone when excessive joint motion is present. Furthermore, there is not a single, specific ligament that is "too tight" that needs to be "stretched out." The muscles supporting the bones are already being "over-worked" and they cannot be strengthened enough to realign these bones. There is no evidence to suggest that any of these measures are effective in re-establishing or maintaining the normal joint alignment and function.
Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.
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