What Is Overpronation

Overview


Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.Pronation


Causes


Over-pronation occurs when the foot collapses too far inward stressing the plantar fascia (the area underneath the arch of the foot.) Normally, one pronates every time he or she walks, but excessive pronation is called over-pronation. When this occurs it can cause pain in the feet, knees, hips, low back and even the shoulder. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.


Symptoms


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.


Diagnosis


When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.Foot Pronation


Non Surgical Treatment


Over-pronation and the problems that go with it are treated with shoe inserts called arch supports or orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom made. Make sure the arch supports are firm. If you can easily bend them in half, they may be too flexible.


Prevention


Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

The Way To Diagnose Calcaneal Apophysitis?

Overview


Sever?s disease, or calcaneal apophysitis, is a common cause of heel pain in patients whose bones are still growing; however, it is not really a disease. The pain is caused by stress at the point where the Achilles tendon meets tissue called the plantar fascia on the growth plate (apophysis) of the heel bone (calcaneus).


Sever's affects boys more often than girls. Boys are most often affected at age 12, and girls at age 9, though Sever's is typically seen in children and adolescents between the ages of 7 and 15.


Causes


Sever's Disease is a repetitive strain injury caused by the following. High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis. Tight calf muscles. Poor mechanics, structure and function of the foot. Excessive pronation. Rapid growth spurt. The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone). It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age. In extreme cases the growth plate can become separated from the calcaneus.


Symptoms


The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems, Heel pain with limping, especially after running. Difficulty walking, Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel, Symptoms are usually worse during or after activity and get better with rest.


Diagnosis


Sever's disease is based on the symptoms reported. To confirm the diagnosis, the clinician will examine the heels and ask about the child's activity level and participation in sports. They may also squeeze the back part of the heel from both sides at the same time to see if doing so causes pain and also ask the child to stand on tiptoes to see if that position causes pain. There may be tightness in the calf muscle, which contributes to tension on the heel. Symptoms are usually worse during or after activity and get better with rest. X-rays generally are not that helpful in diagnosing Sever's disease, but they may be ordered to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.


Non Surgical Treatment


The disease itself is self limiting and will resolve regardless of treatment once the growth plate has fully closed. Depending on the age of the youth at onset this could be a problem for many years. Treatment has always been aimed at managing the pain as well as the inflammation. This is done with the rest, ice, non steroidal anti-inflammatories like ibuprofen, stretching, taping, heel cups, heel lifts and orthotics. In severe cases, cast or walking boot immobilization is used. Each of these have differing levels of efficacy but in my experience orthotics are the golden treatment or the silver bullet. I am not talking about your run of the mill over the counter Dr. Scholls shoe insert. These definitely have their place in the world but not here. Custom molded orthotics made from a mold taken of the youths foot will provide the necessary control and support to stop the pain cycle. We can safely report over 85% of patients who are able to get back to sports and other activities as long as they wear the orthotics in supportive shoes as directed.


Surgical Treatment


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.
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