Pronation is a turning outward of the foot at the ankle, so that one has a tendency to walk on the inner border of the foot. (Pronation is the opposite of supination). When a foot and ankle pronates
to a great degree, we call it over-pronation. During the normal gait cycle, we all pronate and then rapidly recover. It is over-pronation that patients are concerned with. This is a static deformity
associated with flat feet and sometimes with foot and arch pain.
During our development, the muscles, ligaments, and other soft tissue structures that hold our bones together at the joints become looser than normal. When the bones are not held tightly in place,
the joints are not aligned properly, and the foot gradually turns outward at the ankle, causing the inner ankle bone to appear more prominent. The foot moves in this direction because it is the path
of least resistance. It is more difficult for the foot to move in the opposite direction (this is called supination). As we develop, the muscles and ligaments accommodate to this abnormal alignment.
By the time growth is complete, the pronated foot is: abnormally flexible, flat, and its outer border appears raised so that as you step down you do not come down equally across the entire foot;
instead, you come down mostly on the inner border of the foot. Normal aging will produce further laxity of our muscles that causes the pronation to become gradually worse.
When standing, your heels lean inward. When standing, one or both of your knee caps turn inward. Conditions such as a flat feet or bunions may occur. You develop knee pain when you are active or
involved in athletics. The knee pain slowly goes away when you rest. You abnormally wear out the soles and heels of your shoes very quickly.
Bunions, calluses and crooked toes may indicate alignment problems. So, it is important to ascertain the condition of a client's toes. Check the big toe to determine if the first joint of the toe is
swollen, has a callus or bunion, and/or looks as though it abducts (i.e., hallux valgus) rather than pointing straight ahead. Also, look to see if the lesser toes seem to "curl up" (i.e., the person
has hammer or claw toes). This may be indicative of damage to, or inflexibility of the plantar fascia caused by excessive flattening of the foot.
Non Surgical Treatment
If a young child is diagnosed with overpronation braces and custom orthotics can be, conjunction with strengthening and stretching exercises, to realign the bones of the foot. These treatments may
have to continue until the child has stopped growing, and orthotics may need to be worn for life in order to prevent the foot reverting to an overpronated state. Wearing shoes that properly support
the foot, particularly the arch, is one of the most effective treatments for overpronation. Custom-made orthotic inserts can also be very beneficial. They too support the arch and distribute body
weight correctly throughout the foot. Motion-control shoes that prohibit pronation can be worn, so may be useful for those with severe overpronation. One good treatment is to walk barefoot as often
as possible. Not relying on shoes to support the arch will encourage proper muscle use. Practicing yoga can help to correct poor posture and teach you how to stand with your weight balanced evenly
across the whole 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.