n a normal functioning ankle and foot there should be 15- to 20-degrees of ankle dorsiflexion present (leg moving forward on top of the foot; or, same as the foot bending backward toward the leg) as
well as 60- to 65-degrees of first toe extension (bending backward). Foot pronation (turning downward or inward) and supination (turning upward or outward) are normal and needed movements for proper
function during the gait cycle. All feet must do this and do it well in order to minimize the forces that the body has to deal with during walking or running, and also to create the lever that is
needed for propulsion.
There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Often people with flat feet do not experience discomfort
immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
With over pronation, sufferers are most likely to experience pain through the arch of the foot. A lack of stability is also a common complaint. Over pronation also causes the foot to turn outward
during movement at the ankle, causing sufferers to walk along the inner portion of the foot. This not only can deliver serious pain through the heel and ankle, but it can also be the cause of pain in
the knees or lower back as well. This condition also causes the arch to sink which places stress on the bones, ligaments, and tendons throughout the foot. This may yield other common conditions of
foot pain such as plantar fasciitis and heel spurs.
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you
might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the
ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more
prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and
stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space
where your arch did not touch the ground).
Non Surgical Treatment
Overpronation of the feet can be corrected in some cases and in others it can be effectively managed. Overpronators can train themselves to change their running gait, wear arch supports, orthotic
insoles or specialist shoes for overpronators. In order to determine exactly what is happening during the stride, it is necessary to have a gait analysis conducted by a professional. The extent of
overpronation can then be determined, and the causes can be identified and corrected directly. The main corrective methods used for excessive pronation are orthotics. Orthotics are the most
straightforward and simplest solution to overpronation. Orthotics are devices which can be slipped into shoes which will offer varying degrees of correction to the motion of the foot. Orthotics help
to support the arches and distribute the body weight effectively, and are usually the best treatment choice for moderate to severe overpronation. Orthotics may require existing insoles to be removed
from your shoes to accommodate them; although most running shoes will have a removable insole to accommodate an orthotic insole.
Calcaneal "Slide" (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive
option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.