Understanding Foot Pronation

Introduction

Humans are bipedal creatures and, as such, we use our feet for everything such as walking, running, jumping, dancing, etc. With our feet being such a heavily utilized body part, it can frequently become painful due to poor mechanics, weakness, or overuse. It is incredibly common for healthcare providers, fitness professionals, or footwear experts to blame “over-pronation” for foot pain and the solution given is often a more supportive shoe, an expensive orthotic, or just stopping the activity that increases the symptoms all together. Pronation is the motion that occurs as the arch lowers to the floor with every step we take. What if I told you that pronation is not as bad as we might think, and in fact, is a necessary part of walking, running, and sprinting? What if I told you that when we lack the motion necessary to pronate well or we lack the strength to control this pronation, it can lead to overuse injuries and pain such as Achilles tendonitis, plantar fasciitis, bunions, and much more? If you have had any of these pains and were offered any of the solutions above, read on to learn what pronation is and why it is such an important part of our daily lives.

What Is Foot Pronation?

Pronation is a natural, necessary movement of the foot that occurs during the gait cycle. Similar to a spring that coils under load, the arch of the foot drops to the ground as we land on the foot. This movement helps to distribute the forces generated during walking, running, and other weight-bearing activities evenly throughout the foot, ensuring shock absorption and stability. As the foot transitions towards pushing off, the arch of the foot transitions from this coiled position and becomes rigid and stiff. This rigidity provides us with a lever that allows us to spring forward to our next step and repeat the process again and again and again.

The Gait Cycle and Pronation

Understanding the gait cycle is essential for comprehending foot pronation. The gait cycle is the sequence of events that occur when we walk or run, consisting of two main phases: the stance phase and the swing phase.

1. Stance Phase: During this phase, the foot makes contact with the ground and supports the body’s weight. Pronation occurs mainly in the initial and middle portions of stance phase. As the foot makes contact with the ground, the arch of the foot flattens, allowing for shock absorption and adaptation to uneven surfaces. As the foot transitions to later portions of stance phase, the heel begins to lift and the stored energy helps the arch to raise and create a rigid lever for the foot to push off.
2. Swing Phase: In this phase, the foot is not in contact with the ground, and it prepares for the next step. The foot supinates (rolls outward) to regain its arch and prepare to absorb force as it hits the ground next.

Difficulty with Pronation and What Causes It

1. Poor Foot Mechanics: Some individuals have excessive stiffness through the joints of their feet leading to difficulty with achieving pronation.
2. Muscle Imbalances: Weak or tight muscles in the lower leg and foot can affect the foot’s ability to control itself as the arch drops to the floor.
3. Footwear: Shoes that provide too much support can exacerbate the stiffness of these joints in the foot.
4. Injury: Past injuries, especially to the foot or ankle, can lead to stiffness through the midfoot and a lack of pronation.

Effects of Abnormal Pronation

Abnormal foot pronation can lead to a variety of musculoskeletal problems, including:

1. Plantar Fasciitis: An overly rigid foot never achieves a foot flat position, leading to excessive stress and strain through the fascia of the foot.
2. Shin Splints: Difficulty with pronating can lead to an inability to leverage the calf musculature to push off thereby placing an increased demand on the muscles at the front of the shin to lift the foot with each step.
3. Morton’s Neuroma: If the foot is unable to pronate, the toes never spread apart, leading to compression through the toes which could develop into this painful condition
4. Achilles Tendonitis: For the same reason as above, except this could lead to underloading of the Achilles’ tendon and subsequently tendonitis if repetitive stress and strain is introduced to the tendon
5. Knee Pain: Difficulty with achieving and controlling pronation can lead to a lack of tibial internal rotation which can place excessive torque on the knee, leading to knee pain
6. Lower Back Pain: Limited foot pronation alters the body’s ability to absorb and subsequently produce force through that leg during the gait cycle which can lead to excessive stress and strain on the back musculature.

Assessment and Treatment by Physical Therapists

Physical therapists play a crucial role in assessing and managing foot pronation issues. Here’s how they can help:

1. Assessment: Physical therapists use various assessment tools, including gait analysis, movement screening, and manual techniques, to learn how well the foot is moving
2. Manual Therapy: Techniques like joint mobilization and soft tissue manipulation may be used to improve joint mobility and reduce pain.
3. Strengthening and Stretching Exercises: Therapists develop exercise programs to address muscle imbalances and improve foot and ankle mechanics, strength, and flexibility.
4. Improved Biomechanics: PTs can help improve the way your nerves communicate with your muscles to improve the quality of various movement patterns.

Conclusion

Foot pronation is a critical aspect of biomechanics that can significantly impact an individual’s musculoskeletal health and overall well-being. As a physical therapist, I play a role in assessing, diagnosing and treating foot abnormalities effectively. By understanding the causes and effects of foot mechanic issues and implementing tailored interventions, I can help my clients move comfortably and maintain healthy, functional feet. If you or someone you know is experiencing foot problems, don’t hesitate to seek the guidance of a qualified physical therapist for proper evaluation and treatment.

Dr. Joshua Ambeau, PT, DPT