Thursday, March 2, 2017

Injures Caused by Foot Overpronation

Foot Overpronation Can Cause Many Different Injures.

Pronation of the foot involves dorsiflexion of the ankle, abduction of the foot, and eversion of the foot. In layman's terms this is described below, but the important aspect is that these movements drop the medial arch of the foot.
  • Dorsiflexion involves a bend of the ankle in the direction of the dorsum or top of the foot. It brings the top of the foot towards the knee.
  • Abduction is a turning out of the foot away from the midline.
  • Eversion is a turning out of the foot which brings the medial arch down.
Fig. 1: Comparing a neutral foot (middle) to foot overpronation (left) and supination (right). Notice how the pronated foot turns away from the midline (this is abduction) and the medial arch falls towards the floor (this is eversion). Image Ducky2315 (Own work) [CC BY-SA 3.0 9]

A certain amount of pronation is normal in weight bearing as this acts as a shock absorption. Connective tissue structures in the foot elongate and produce a certain amount of tension which, upon recoil, helps propel the movement, thus acting as an energy saving mechanism during walking and running. However, overpronation is a frequent occurrence which is an excessive pronation. This can lead to a range of injuries of the foot, ankle and lower leg, but also can cause or contribute to injuries of the knee, hip and really anywhere in the body.

Frequent injuries are listed below with a brief description of how overpronation contributes.

  • Plantar fasciitis/fasciosis: As the foot goes excessively into pronation, the plantar fascia is overstretched. The reoccurring motion eventually irritates the plantar fascia and can lead to chronic pain in the bottom of the foot, usually where this tissue attaches to the calcaneus.
Fig. 2: Both tibialis anterior and tibialis posterior attach to 
the medial arch. In foot overpronation, the arch drops and these 
muscles are pulled long. This can irritate the tendons of these 
muscles and can also contribute to shin splints.

  • Tibialis posterior tendinopathy: This condition can be misdiagnosed as plantar fasciitis, but pain is usually more at the medial ankle. The tibialis posterior supports the medial arch and can become irritated with excessive pronation as it too is repetitively overlengthened when walking or running.
  • Shin splints: Shin splints can be classified as anterior or medial shin splints. The involve either the tibialis anterior or the tibialis posterior, respectively. Both of these muscles support the medial arch and can have a shearing effect where they attach to the tibia with overpronation.
Fig. 3: Note the effects on the knee and hip.
  • Knee pain: There are many knee conditions that can become aggravated with overpronation. As the foot pronates, the lower leg turns inward. This becomes excessive with overpronation, and the knee tends to collapse in. This can contribute to medial knee pain from conditions such as pes anserine tendinopathy or lateral knee pain from conditions such as iliotibial band friction syndrome.
  • Hip pain: Like knee pain, there are many hip conditions that can be aggravated from foot overpronation. One example is greater trochanteric bursitis which is often caused by an excessive raising of the hip during weight bearing. This frequently occurs with foot overpronation and with the knee moving in.
  • Back pain, shoulder pain, neck pain: Foot overpronation can be involved with many other muscle imbalances as described above with knee pain and hip pain. These imbalances can affect regions as far away as the neck.
Sports Medicine Acupuncture® is a great system for treating both the injury and the underlying causes of the injury such as foot overpronation. It employs acupuncture, manual therapy, and corrective exercises in addition to other possible treatment options. Both local acupuncture and manual therapy techniques can be used to reduce pain and improve the health of the injured soft tissue. And acupuncture to specific points within the muscles can correct the underlying muscle imbalances that occur with foot overpronation which lead to the injury and, if uncorrected, will cause a recurrence. Corrective exercises help the treatment hold and further corrects the underlying muscle imbalance.

Fig. 4
A simple exercise which can strengthen the intrinsic muscles of the foot and help to correct foot overpronation is the short foot exercise. This exercise strengthens the adductor hallucis (hallucis refers to the big toe) muscle (Fig. 4), in particular. The following steps are followed to perform this exercise:

  1. Sit upright with both feet flat on the floor. Alternately, the exercise can be performed standing on the foot to be exercised. This is more advanced.
  2. Raise the arch of your foot by bringing your big toe towards your heel. The trick is to do this without curling your toes. Your emphasis is on lifting the arch away from the floor.
  3. Hold for 5-10 seconds. You can perform this exercise multiple times. 
While this exercise is helpful, foot overpronation often involves other structures not only in the foot. These include muscle imbalance in the lower leg, knee and thigh, hip and low back. Comprehensive work with these structures is often necessary for lasting effects. Evaluation and treatment of these contributing muscle imbalances along with treatment of associated injuries are what your certified Sports Medicine Acupuncturists® work with.

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