When standing, pronation occurs as the foot rolls inwards and the arch of the foot flattens. Pronation is a normal part of the gait cycle which helps to provide shock absorption at the foot. The
opposite movement to pronation is supination. This is also a normal part of the gait cycle just after the heel strike however over-supination is also not good.
Overpronation often occurs in people with flat feet, whose plantar fascia ligament is too flexible or too long, and therefore unable to properly support the longitudinal arch of the foot. People tend
to inherit the foot structure that leads to overpronation. In a normal foot the bones are arranged so that two arches are formed, the longitudinal and the transverse. Ligaments hold all the bones in
their correct positions, and tendons attach muscles to bones. If the bones are held together too loosely, they will tend to move inwards as this is the easiest direction for them to go. Over time the
soft tissue structures will adjust to the misalignment and the foot will become permanently over-flexible, with a flat arch.
When standing, your heels lean inward. When standing, one or both of your knee caps turn inward. Conditions such as a flat feet or bunions may occur. You develop knee pain when you are active or
involved in athletics. The knee pain slowly goes away when you rest. You abnormally wear out the soles and heels of your shoes very quickly.
To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing
activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are
working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then
structural changes and clues in the feet are visible and indicate habitual overpronation.
Non Surgical Treatment
Solutions typically presented will include physical therapy sessions, prolonged prescription drug regimens, occasionally non-traditional approaches like holistic medicine and acupuncture. These
options can provide symptom relief in the short term for some patients. However, these treatment methods cannot correct the internal osseous misalignment. Ligaments are not effective in limiting the
motion of the ankle bone when excessive joint motion is present. Furthermore, there is not a single, specific ligament that is "too tight" that needs to be "stretched out." The muscles supporting the
bones are already being "over-worked" and they cannot be strengthened enough to realign these bones. There is no evidence to suggest that any of these measures are effective in re-establishing or
maintaining the normal joint alignment and function.
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.