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Pronation is a rotational movement of the forearm (at the radioulnar joint) or foot (at the subtalar and talocalcaneonavicular joints) Pronation of the foot refers to how the body distributes weight during the gait cycle.
Types of pronation include neutral pronation, underpronation (supination), and overpronation..Pronation depends not on the shape of the foot or on the shape of the static arch, but on how much and how long the arch collapses when the foot goes through its walk cycle.An individual who neutrally pronates initially strikes the ground on the outer side of theheel As the individual transfers weight from the heel to the forefoot , the foot will roll in a inward direction, such that the weight is distributed evenly across the metatarsus. In this stage of the gait, the knee will generally, but not always, track directly over the big toe.This "rolling inwards" motion as the foot progresses from heel to toe is the way that the body naturally absorbs shock. Neutral pronation is the ideal, most efficient type of gait.
Overpronation:
The overpronated foot is one in which the heel bone angles inward and the arch tends to collapse. A knock kneed person has overly pronated feet .As with a neutral pronator, an individual who overpronates initially strikes the ground on the outer side of the heel. As the individual transfers weight from the heel to the metatarsus, however, the foot will roll too far in a medial direction, such that the weight is distributed unevenly across the metatarsus, with excessive weight borne on the big toe In this stage of the gait, the knee will generally, but not always, track inwards.
An overpronator does not absorb shock efficiently.An overpronator's arches will collapse, or the ankles will roll inwards (or a combination of the two) as he or she cycles through the gait. .
This action can lead to foot pain as well as knee pain,shin splints, achilles tendonitis, posterior tibial tendinitis, and plantar fasciitis
Overpronation of the foot is a finding, not a diagnosis .It is important to bear in mind that many people overpronate but do not get symptoms ( as yet! It is still not ideal). Also that an overpronating foot may not be overpronating because of a problem with the foot itself ! For example, internal rotation (turning in) of the hip - due possibly to a weak or inhibited gluteus maximus muscle or tight internal rotators - can lead to pronation, So can “knock knees”. (which might be due to excessive femoral anteversion - detectable by your osteopath by Craig's Test)
You can feel this for yourself – if you clench your buttock muscles you will feel your hips rotate outward slightly and the insides of your soles rising.
Underpronation (supination):
An individual who underpronates also initially strikes the ground on the outside side of the heel. As the individual transfers weight from the heel to the metatarsus, the foot will not roll far enough in a medial direction. The weight is distributed unevenly across the metatarsus, with excessive weight borne on the little toe, towards theouter side of the foot. In this stage of the gait, the knee will generally, but not always, track laterally of the hallux.Like an overpronator, an underpronator does not absorb shock efficiently - but for the opposite reason.. There is almost no give. An underpronator's arches or ankles will not experience much motion as he or she cycles through the gait.. Usually - but not always - those who are bow legged tend to underpronate.A common injury associated with underpronation is ilio-tibial band syndrome.
In some patients, an orthotic may be at best a partial solution .But it could aggravate other parts of the body such as the knees while sparing the feet. So you should have a full musculo-skeletal examination an osteopath. This can reveal a more complex picture than just overpronation at the foot and you may need wider attention than just prescribing an orthotic. For example, patients may need foot strengthening or taping , proprioceptive (balance) training , abdominal and gluteal strengthening, foot, leg or spinal manipulation, or even nutritional advice. This can only be determined by looking at the whole patient, not just their feet or legs. . As always, the individual patient has to be examined and care based on a total assessment
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