Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion,
and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body.
When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes
collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.
There is a relationship between biomechanics and injury that is specific to each body part. Overall though, poor mechanics will either increase the landing forces acting on the body or increase the
work to be done by the muscles. Both increase the stress, which, depending on the individual and the amount of running can become excessive and cause injury.
Due to the laxity of the soft tissue structures of the foot, and the fact that the joints are not held together properly, the bones of the feet shift. When this occurs, the muscles that attach to
these bones must also shift, or twist, in order to attach to these bones. The strongest and most important muscles that attach to our foot bones come from our lower leg. So, as these muscles course
down the leg and across the ankle, they must twist to maintain their proper attachments in the foot. This twisting of these muscles will cause shin splints, Achilles Tendonitis, generalized
tendonitis, fatigue, muscle aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). The problems we see in the feet, which are due
to over-pronation include bunions, heel spurs, plantar fasciitis, fallen and painful arches, hammertoes, metatarsalgia (ball of foot pain), and calluses.
If you cannot afford to get a proper gait analysis completed, having someone observe you on a treadmill from behind will give you an idea if you are an overpronator. It is possible to tell without
observing directly whether you are likely to be an overpronator by looking at your foot arches. Check your foot arch height by standing in water and then on a wet floor or piece of paper which will
show your footprint. If your footprints show little to no narrowing in the middle, then you have flat feet or fallen arches. This makes it highly likely that you will overpronate to some degree when
running. If you have low or fallen arches, you should get your gait checked to see how much you overpronate, and whether you need to take steps to reduce the level to which you overpronate. Another
good test is to have a look at the wear pattern on an old pair of trainers. Overpronators will wear out the outside of the heel and the inside of the toe more quickly than other parts of the shoe. If
the wear is quite even, you are likely to have a neutral running gait. Wear primarily down the outside edge means that you are a supinator. When you replace your running shoes you may benefit from
shoes for overpronation. Motion control or stability running shoes are usually the best bet to deal with overpronation.
Non Surgical Treatment
Heel counters that make the heel of the shoe stronger to help resist/reduce excessive rearfoot motions. The heel counter is the hard piece in the back of the shoe that controls the foot?s motion from
side-to-side. You can quickly test the effectiveness of a shoe?s heel counter by placing the shoe in the palm of your hand and putting your thumb in the mid-portion of the heel, trying to bend the
back of the shoe. A heel counter that does not bend very much will provide superior motion control. Appropriate midsole density, the firmer the density, the more it will resist motion (important for
a foot that overpronates or is pes planus), and the softer the density, the more it will shock absorb (important for a cavus foot with poor shock absorption) Wide base of support through the midfoot,
to provide more support under a foot that is overpronated or the middle of the foot is collapsed inward.
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