How many of you have gone to your favorite therapist, doctor or shoe store complaining of some sort of pain? You got a cursory evaluation; were fitted with shoes or orthotics and found that indeed your complaint(s) resolved; but only to find yourself complaining of something else hurting you a few weeks later without having changed anything else in your training.
In order to correctly determine if an overpronation should be corrected using shoes or orthotics, a functional and a structural examination is mandatory. This requires an evaluation of the pelvis, hip, knee, ankle and foot ranges of motion along with at least a lunge and a squat test to examine other elements of motion such as force production, force dissipation, proprioception, stability and balance.
Leg lengths should be examined to rule out inequalities. The pelvis and the spine must be evaluated for proper joint motion and alignment. Last but not least, muscle length and strength ratios may need to be assessed. Without these factors being accurately examined, an improper correction could be made, which will eventually result in other dysfunctions and ensuing pain.
One of the common and frequent reasons for overpronation is a lack of normal ankle range of motion. If the foot/ankle is unable to dorsiflex (bend backward) properly, it will not allow the knee to travel forward enough for the body to move its center of mass over the foot, hence making the forward motion of the body difficult.
In such a case, the foot is forced to pronate excessively and as a result the knee will drift medially (toward midline) and the hip will have to excessively adduct (move toward midline) and internally (turn inward) rotate. This of course continues into the rest of kinetic chain and results in other abnormalities in motion mechanics.
In this particular (and quite common) instance of poor ankle mobility, correction through shoes and orthotics is often asking for trouble. The overpronation in this case is a needed compensation for a lack of mobility elsewhere in the body. Taking this compensatory element away without first addressing and correcting the true underlying cause will inevitably force compensation (frequently accompanied by pain) in another part of the body.
Here is a simple test you can perform to see if you fall under this particular category:
While in a standing position, place your feet shoulder-width apart. Make sure that your feet and toes are pointing forward and not turned outward (away from the midline of the body). See if you can get into a squatting position that places your knees at or below 90 degrees of flexion (bending) without your heels coming off the ground or your feet externally rotating (turning outward).
If you are unable to complete this test, then there is a good chance your foot pronation is due to inflexibility of your ankles and that is what should be corrected, not the pronating foot. Please note that there are other factors, beyond the scope of this article that can be involved here as well.
Before you consider correcting foot pronation, be sure to have a detailed and complete structural and functional evaluation done by a qualified provider. Not doing so may cost you much more than an improperly fitted shoe or useless pair of orthotics. Remember that the real question to that should be answered is not if you over pronate, but why.Are you training for a race? Sign up for your next running event.
Dr. Hamid Sadri is a sport chiropractor from Atlanta, Georgia, with over 24 years of experience. He holds certifications from the American Chiropractic Board of Sports Physicians, National Academy of Sports Medicine, National Strength & Conditioning Association, Graston Technique and Active Release Techniques. He has worked with national and international athletes of all levels and was selected as one of America's Top Chiropractors by the Consumer's Research Council. Contact: DrSadri@1stChoiceOnline.com.