Pronation is the way the foot rolls inward when you walk and run. It is part of the natural movement that helps the lower leg deal with shock. Some people pronate more (overpronation) or less (underpronation) than others. Though this is not bad in itself, it does affect the way you run and it may increase the likelihood of injury. This makes your pronation pattern an important factor in choosing the right shoes.
Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Common conditions seen with overpronation include heel pain or plantar fasciitis, achilles tendonopathy, hallus valgus and or bunions, patellofemoral pain syndrome, Iliotibial band pain syndrome, low back pain, shin splints, stress fractures in the foot or lower leg.
Firstly, look at your feet in standing, have you got a clear arch on the inside of the foot? If there is not an arch and the innermost part of the sole touches the floor, then your feet are over-pronated. Secondly, look at your running shoes. If they are worn on the inside of the sole in particular, then pronation may be a problem for you. Thirdly, try the wet foot test. Wet your feet and walk along a section of paving and look at the footprints you leave. 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, shown opposite. The best way to determine if you over pronate is to visit a podiatrist or similar who can do a full gait analysis on a treadmill or using forceplates measuring exactly the forces and angles of the foot whilst running. It is not only the amount of over pronation which is important but the timing of it during the gait cycle as well that needs to be assessed.
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.
Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint.
Sever?s disease is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 14 years of age. Sever?s disease will go away on its own when it is used less or when the bone is through growing, but it can recur (for example, at the start of a new sports season). Traditionally, the only known cure was for children to outgrow the condition, with recurrences happening an average of 18 months before this occurs.
Sever's Disease typically affects boys and girls between 8-15 years of age. Risk factors include. Athletic activity that involves heel contact with hard surfaces, as in gymnastics, track, soccer, basketball, ice skating, ballet and aerobics. The wearing of ill-fitting shoes. Well-made shoes that fit properly are a must for every child. Prolonged periods of standing. If a child complains of heel pain after choir practice, doing dishes, standing in lines or other activities that put pressure on the heel bones, pay attention.
On examination, the typical signs are tenderness on palpation of the heel, particularly on deep palpation at the Achilles tendon insertion. Pain on dorsiflexion of the ankle, particularly when doing active toe raises; forced dorsiflexion of the ankle is also uncomfortable. Swelling of the heel, usually mild. Calcaneal enlargement, in long-standing cases.
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.
Non Surgical Treatment
First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 25 minutes three times a day. Your child should not go barefoot. If your child has severe heel pain, ibuprofen (Advil) will help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches five times each, two or three times a day. Each stretch should be held for 20 seconds. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, have your child stand facing a wall to stretch the calves and the heel cord. Place one foot a shoulder?s width in front of the other, both feet facing the wall. The front knee is bent and the back knee is straight during the calf stretch. Then have your child push against the wall and feel the stretch in his or her back leg. To stretch out the heel cord, have him or her stay in the same position and bend the back knee. Repeat three times. Practice this stretch twice daily.
The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
Overview Another common term for this condition is Posterior Tibial Tendon Dysfunction (PTTD). There is a cause-effect relationship between pronation, flatfoot deformity and subsequent tenosynovitis of the posterior tibial tendon. Mechanical irritation of the tendon may lead to synovitis, partial tearing and eventually full rupture of the tendon. Other structures, including ligaments and the plantar fascia, have also been shown to contribute to the arch collapsing. As the deformity progresses, these structures have been shown to attenuate and rupture as well. In later stages, subluxation of various joints lead to a valgus rearfoot and transverse plane deformity of the forefoot. These deformities can become fixed and irreducible as significant osteoarthritis sets in. Causes The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older. Symptoms In many cases, adult flatfoot causes no pain or problems. In others, pain may be severe. Many people experience aching pain in the heel and arch and swelling along the inner side of the foot. Diagnosis It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon. Non surgical Treatment The adult acquired flatfoot is best treated early. There is no recommended home treatment other than the general avoidance of prolonged weightbearing in non-supportive footwear until the patient can be seen in the office of the foot and ankle specialist. In Stage I, the inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up treatment with custom-molded foot orthoses and properly designed athletic or orthopedic footwear are critical to maintain stability of the foot and ankle after initial symptoms have been calmed. Once the tendon has been stretched, the foot will become deformed and visibly rolled into a pronated position at the ankle. Non-surgical treatment has a significantly lower chance of success. Total immobilization in a cast or Camwalker may calm down symptoms and arrest progression of the deformity in a smaller percentage of patients. Usually, long-term use of a brace known as an ankle foot orthosis is required to stop progression of the deformity without surgery. A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed. Surgical Treatment When conservative care fails to control symptoms and/or deformity, then surgery may be needed. The goal of surgical treatment is to obtain good alignment while keeping the foot and ankle as flexible as possible. The most common procedures used with this condition include arthrodesis (fusion), osteotomy (cutting out a wedge-shaped piece of bone), and lateral column lengthening. Lateral column lengthening involves the use of a bone graft at the calcaneocuboid joint. This procedure helps restore the medial longitudinal arch (arch along the inside of the foot). A torn tendon or spring ligament will be repaired or reconstructed. Other surgical options include tendon shortening or lengthening. Or the surgeon may move one or more tendons. This procedure is called a tendon transfer. Tendon transfer uses another tendon to help the posterior tibial tendon function more effectively. A tendon transfer is designed to change the force and angle of pull on the bones of the arch. It's not clear yet from research evidence which surgical procedure works best for this condition. A combination of surgical treatments may be needed. It may depend on your age, type and severity of deformity and symptoms, and your desired level of daily activity.