By Ana Soulia, PT, DPT | Inertia Physiotherapy, Missoula, MT
Short answer, yes. Everyone is a pronator! Pronation is a 3-dimensional movement that results in the whole foot growing longer and wider as it fans to absorb shock when walking, running and jumping. True pronation can only occur when your foot is on the ground. Pronation is balanced by Supination. Supination is the position of the foot where it has become a rigid lever for pushing off. In normal pronation, the arch gets a bit lower and longer. In normal supination the arch folds up and gets a bit shorter and narrower. Both phases are important for normal foot function. Pronation isn't your foot collapsing inwards, (more on that later). However, some people do "over-pronate." The over pronated foot is unlocked for too much of the gait cycle. This can leave structure like the plantar fascia vulnerable and cause your muscles to work too hard and lead to repeated strain or stiffness.
Are you an over-pronator?
Maybe. If you over pronate, your arch will overly flatten when weight bearing. (Side note: This is different than a flat foot. In the case of a flat foot, your foot is flat as a pancake regardless of the presence of weight on your foot). Often when you pick an over-pronated foot up off the ground, you see an arch form. It’s only when you weight bear on the foot that your arch drops down more than desired. These individuals are often put in rigid orthotics and/or they wear highly engineered footwear to compensate for their “collapsed” arch.
That sounds like me, why do you say maybe?
Another common dysfunction of the foot that is often misdiagnosed as over pronation is a medial talar tilt. This problem results from a stiff rear-foot and mid-foot that are not allowing your big toe to easily get to the ground. This is very common and frequently diagnosed as over-pronation by an untrained eye such as your well meaning local shoe store associate. The reason is because it will functionally appear that your are collapsing inwards because of poor arch control. However, in this case, you'd likely be surprised to learn that your foot is actually stuck in supination and lacking proper pronation. In other words, you are actually an "under pronator." In the image above, my right foot is showing you a medial talar tilt. Look at the crease outside of my ankle. That's what it will look like if your ankle joint isn't lined up properly. This is a non-physiological position of the foot and ankle and a likely culprit for problems both in the foot and up the kinetic chain.
Similar to over-pronators, people with medial talent tilt will often have a normal looking arch with their foot off the ground. In weight bearing though, their whole foot and ankle collapses to the inside and their toes turn out in a duck foot position. This is the strategy they use to get the inside of their foot and big toe grounded. Their shoes will often bulge to the inside and they have large callouses on the inside of their big toes. They often complain of knee issues because the knee falls in following the rear foot and they frequently complain of Piriformis muscle tightness because it is constantly working too hard to control the position of the knee. Often, but not always these individuals have a history of ankle sprain that wasn't rehabbed properly. The only way to know for sure if this is you, is to have your foot evaluated by a professional such as a physical therapist.
I like my supportive shoes and my feet don't hurt, so why should I care?
Individuals with over pronation and medial tilt can suffer from foot issues like plantar fasciitis, achilles tendonitis and bunyons, but corrective footwear is also prescribed for knee pain, hip pain, lower back pain and even neck pain. There are times when foot correction using shoes and/or orthotics are valuable tools for an over-pronator. A person with medial talar tilt likely won’t benefit from correction in the long term and they will often develop more issues up the chain as a result. Over time, their already stiff foot will become more-stiff and drive further compensation. These individuals need to have their foot mobilized first to restore the normal physiological functions of pronation and supination. Then, in both cases, foot strengthening can help normalize function and reduce the need for expensive orthotics and stiff shoes. This can have positive impacts on your whole body and allow you to wear sandals without pain or compromise.
Strengthening the muscles that control and support your arch can lead to resolving over-pronation and creating a foot that effectively uses both normal pronation and supination. Restoring control of the foot also allows you to control the forces of the knee and hip with less energy leading to reduced muscle tension in these areas meaning less need to foam roll and stretch. It allows you to absorb shock and take stress off your lower back and pelvis. It trains your foot to be a strong lever that gives you proper force propulsion through to your glute when you’re walking and running.
The following is just a few of the things you can try to strengthen your feet. There are a variety of factors as to why this likely won't be a full solution. If you're interested learning more about your feet and you're in the Missoula areas, you can schedule your FREE in person consultation at Inertia Physiotherapy. There is no obligation and you could learn a lot about how to manage your feet. Call or Text 406-880-7945 or visit www.InertiaPhysioMT.com to learn more.
Toe Yoga: Strengthen your arches by challenging yourself to move your toes in various patterns.
Leave your outer 4 toes down and lift your big toes up
Leave your big toes down and lift your outer 4 toes up
Leave your big toe and baby toes down and lift your middle three up
Medial Arch Strength: Lift and lower a small ball with your big toes and feel the tension build along the inside of your arches. You are strengthening hour Abductor Hallicus Brevis. Say that 10 times fast!!
Lift and lower your arches against the band keeping big toes down. This exercises strengthens your Posterior Tibialis Muscle. This muscle is the primary muscle that creates supination of the midfoot and allows pronation of the midfoot. If this is difficult to do with resistance, start without a band. Do this exercise in standing. The rotation that starts at your feet will transfer all the way up to your hips.
Feet are pretty amazing and do a whole lot for us. If you're struggling with foot, ankle, knee, lower back or hip pain and you've been told you need expensive custom orthotics but you'd like to learn how to train your feet to be feet and you're in the Missoula area, call or text 406-880-7945 or visit our website www.InertiaPhysioMT.com to schedule your free Consultation or Initial Evaluation today!
About the Author- Ana Soulia is a Dr. of Physical Therapy and founder of Inertia Physiotherapy in Missoula Montana. She specializes in treating persistent pain and nagging injuries. She is passionate about helping her clients move well and enjoy an active Montana Lifestyle. Her Integrative Approach to PT emphasizes the need to evaluate the whole person to effectively treat stubborn problems. If you are in the Missoula area and you'd like to know more about Ana and how her practice is different please visit www.InertiaPhysioMT.com and schedule a FREE Discovery Session.
1001 S 4th St W Suite 4
Missoula, MT 59801
406-880-7945