Feet that flatten out upon standing are referred to as pronated. Pronation means that the ankles roll in towards each other and the arches flatten.
Some people have a fairly high arch when they are sitting, but as soon as they stand up, their feet collapse.
Is Pronation a Bad Thing?
No and Yes. Pronation is required when we walk so that when the heel strikes the ground, the foot rolls in to absorb shock and to adapt to the supporting surface, particularly on uneven surfaces. Therefore, pronation is a normal, necessary component of walking.
It becomes a bad thing when the foot remains pronated throughout the walking cycle. Therefore, the heel strikes the ground and pronates to absorb shock, but then at the midstance phase of the walking cycle, the foot has to reposition to become a rigid lever for pushing off effectively with every step. If the foot remains collapsed or pronated, then muscles and tendons will strain and the foot shows excessive signs of wear and tear.
What Are The Problems Associated With Pronation?
Commonly, people experience generalized pain or fatigue in their feet, or sometimes arch pain or even heel pain. When you stand up first thing in the morning and your heels are sore, this is because the foot is bearing weight, pronating and the band that extends from the heel to the ball of the foot stretches and pulls excessively as the foot collapses. Pronation can cause enlarged toe joints (bunions), pinched nerves (neuroma), callous formation at the ball of the foot, heel pain, arch pain, ankle soreness or even lower leg or knee pain.
How Do The Feet Affect The Rest Of The Body?
If your feet collapse or pronate, then the lower legs rotate inwards and the knees are affected. The knee cap can move side-to-side which creates a problem called “runner’s knee” or “patellofemoral syndrome”. Furthermore, if the feet collapse, then the muscles and tendons extending from the lower leg down to the foot stretch or strain excessively (often referred to as “shin splints”).
How Is Pronation Caused?
Pronation becomes evident around the age of 3 or 4. When children first start to walk, their feet are quite flat and there is a fat pad under the arch, and this is normal. By the age of 3 or 4, children’s feet should be stable.
However, because of tilting of the bones of the foot, this problem may remain as children grow and as a result, the bones of the feet strike the ground on an angle and so the feet compensate and roll in. This is the pronation that we commonly see in childhood. If left untreated, then children go on to develop with pronated feet which can result in problems in adulthood.
If adults that have bunions for example, had been treated as a child, then the bunions could have been prevented from progressing. Often the foot structure is inherited, but by correcting the foot mechanics, the problems that result from the inherited foot structure can be prevented.
What Can Be Done About Pronation?
Many years ago doctors used to recommend wedges, arch pads or other types of “cookies” or modifications to the shoe. Research in podiatric biomechanics for the past 25 years has demonstrated that shoe modifications are not enough. Orthotic devices are used to correct biomechanical abnormalities of the foot. Orthotics are prescription inserts that are worn comfortably in the shoes and they are made following a plaster cast of the foot.
What Types Of Orthotics Are Best?
Many stores and clinics are now treating feet with shoe inserts, even though they are not foot specialists. Orthotics have been so successful in the podiatry profession that many with little training on the foot have decided to treat foot pain as a side line. One should be careful where they get orthotics. Retail stores or booths at trade shows or malls make what they call orthotics on the spot. Basically all they are doing is taking a tracing of your foot, or getting an imprint and you wind up with an off-the-shelf device which is no more than an arch support that you would buy in a drugstore. These may provide a bit of support or temporary comfort, but they do not control the mechanics of the gait cycle. They are not true “orthotics”.
Arch Supports from drug stores may provide some temporary relief or insoles from sporting shops may control pronation to a degree. However, they are not specific enough to precisely control the foot motions during the walking cycle.
Podiatrists use plaster casts of the feet in their corrected position in order to exactly control the mechanics of the walking cycle. A plaster cast enables a laboratory to fabricate an orthotic device that is made exactly to your foot and in this way it will be comfortable. The best available orthotics were always made by prescription with a plaster cast of your feet. Now replacing plaster casts is a 3D laser scanner which captures your feet in a non weight bearing "neutral" position and thereby creates a virtual cast of your feet in their ideal corrected position.
Avoid Foam Impressions For Orthotics
Many allied health workers make what they call an orthotic and have you step in a foam box. This is quick and easy for them and not messy. However, by stepping in a foam impression, a deviated position of the foot is captured and hence adequate control of the foot mechanics cannot be achieved. There is quite a bit of guesswork involved since these orthotics are usually made from a standard stock size item. It’s best to avoid orthotics made from a foam impression.
What About Computerized Orthotics?
Many places are now using a computerized gait analysis. They have you step on a pressure pad and a digitalized read-out of your footprint is seen on a screen. This is very impressive and will show where there are pressure points on the foot. This computerized gait analysis helps to make the person that is using it look like they really know what they are talking about when it comes to the feet, even if they know very little about podiatric medicine!
Caution however: The orthotics that are made after this computerized gait analysis are in fact basically an off-the-shelf device of a standard stock size to match your shoe size and to approximate the height of the arch. The devices are not made by a computer, and it is only the gait analysis that is computerized. This gait analysis basically confuses the issue and it makes it appear as though you are getting computerized orthotics. You are not, and as a result the correction or control of the foot mechanics may be limited or ineffective.
If you are having problems with your feet and your feet are pronated, you are best off having your feet looked at by a podiatrist in order that proper correction can be achieved for the many years of walking that you have ahead of you.