What are the treatment options for individuals dealing with foot overpronation when the foot and ankle move too much downward and inward?

Overpronation

Pronation is the normal foot and ankle movement when taking a step and is usually associated with flat feet. Overpronation is a movement pattern in which the ankle rolls inward and downward, causing the foot’s arch to collapse with each stride. Overpronation can strain the muscles and ligaments in the feet and legs, leading to heel pain, ankle pain, shin splints, and low-back pain. (Pedorthic Association of Canada, 2023) Orthotic inserts for shoes, prescribed stretches, ankle braces, physical therapy, and surgery can all help alleviate the impact of overpronation. (Sánchez-Rodríguez, R. et al., 2020)

Signs and Symptoms

Some individuals with overpronation can have no symptoms at all. (Pedorthic Association of Canada, 2023) while others experience pain or other symptoms in their legs and feet. Overpronation is not a medical condition but a movement pattern that, if left untreated, can increase the risk for certain medical conditions because it strains the feet and leg muscles, joints, and ligaments. (Sánchez-Rodríguez, R. et al., 2020) Certain medical conditions can be a sign of overpronation and include: (Pedorthic Association of Canada, 2023)

• Bunions
• Heel pain
• Plantar fasciitis
• Achilles tendon pain
• Posterior tibial tendonitis
• Shin splints
• Knee pain, including patellofemoral pain syndrome
• Pain in the iliotibial or IT band
• Lower back pain
• Arthritis in foot and ankle joints
• Stress fractures

Individuals may also experience pain in the midfoot or hips, which can be a symptom of flat feet.

Underpronation

Pronation refers to the normal movement of the foot and ankle while walking. Overpronation and underpronation are both abnormal movement patterns.

• Overpronation – when the ankle rolls too much inward and downward.
• Underpronation – occurs when an individual’s foot lacks flexibility and moves too little. This condition is called supination and is often associated with a high-arch foot type.
• This often places added pressure on the outside of the foot, leading to other ankle and foot problems. (Pedorthic Association of Canada, 2023)

Causes

Overpronation can be caused or worsened by flatfeet. However, some individuals have overpronation because their feet and ankles are very flexible, so they tend to move more. Risk factors for flatfeet can also increase the chances of developing overpronation and include:

• Age, especially individuals over 40.
• Wearing shoes like high heels and shoes with a narrow-toe box.
• Women are more prone to overpronate because of the various shoes and high heels worn.
• Being overweight
• Doing repetitive, impactful movements like running.

Correction and Treatment

Treating overpronation focuses on alleviating strain on muscles in the foot, ankle, and leg to relieve symptoms in the heel, ankle, knees, hips, or back. Common treatments are wearing supportive shoes and/or using foot orthotics. Exercises and stretches are also recommended to maintain flexibility and strength. Surgery is rare, but correcting flat feet that can cause overpronation may be recommended. (Sánchez-Rodríguez, R. et al., 2020) Individuals with overpronation are advised to see a podiatrist who can explain the best treatment options.

Supportive Shoes

The first course of treatment is to wear added supportive footwear. This can include specialized shoes or inserts that support the foot and reduce ankle movement. Individuals are advised to use shoes with firm heel and midfoot support to help prevent disproportionate movement. (Pedorthic Association of Canada, 2023)

Orthotics

A healthcare provider can recommend orthotics for individuals with moderate overpronation. These are meant to support the foot, especially the arch, and reduce overpronation. (Naderi A. Degens H. and Sakinepoor A. 2019) Individuals can purchase orthotics from shoe stores and elsewhere, but those with severe overpronation may need custom orthotics molded to the foot to provide individualized support.

Exercises and Stretches

Exercises and stretches can also help. A study found that exercises targeting the feet, core, and hips helped correct pronation over nine weeks. The exercises included: (Sánchez-Rodríguez, R. et al., 2020)

• Toe pickups in which the individuals grab small objects with their toes and move them from one position to another.
• Flexing and pointing the toes using a resistance band placed around the toes.
• Hip abduction exercises to target the hip and glutes.
• Abdominal and oblique muscle exercises to stabilize the torso.
• Short-foot exercise raises the foot arch off the ground, drawing the toes toward the heel. (Sulowska I. et al., 2016)

Surgery

Rarely will surgery be needed to treat flat feet and severe overpronation. But if necessary, reconstruction realigns the bones to support the arch better and reduce overpronation. A metal implant is used for flatfeet to stabilize the area. Surgery can also repair torn tendons or other damage contributing to overpronation. (Healthline, 2020)

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals with overpronation but no symptoms don’t necessarily have to see a healthcare provider since this may be the body’s natural movement pattern. But if the feet, legs, hips, or back begin to present with pain and other symptoms, see a healthcare provider who can evaluate gait and recommend treatment options. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

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Enhance Performance with Functional Foot Orthotics

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References

Pedorthic Association of Canada. (2023). Overpronation and Underpronation Correction. pedorthic.ca/services/foot-health/pronation/

Sánchez-Rodríguez, R., Valle-Estévez, S., Fraile-García, P. A., Martínez-Nova, A., Gómez-Martín, B., & Escamilla-Martínez, E. (2020). Modification of Pronated Foot Posture after a Program of Therapeutic Exercises. International journal of environmental research and public health, 17(22), 8406. doi.org/10.3390/ijerph17228406

Naderi, A., Degens, H., & Sakinepoor, A. (2019). Arch-support foot orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. European journal of sport science, 19(2), 247–257. doi.org/10.1080/17461391.2018.1503337

Sulowska, I., Oleksy, Ł., Mika, A., Bylina, D., & Sołtan, J. (2016). The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PloS one, 11(6), e0157917. doi.org/10.1371/journal.pone.0157917

Healthline. (2020). All About Surgery for Flat Feet: Pros and Cons. www.healthline.com/health/flat-feet-surgery