When we are treating patients, we discover a huge percentage have signs of over pronation that we can link to the pain or instability or both that they present with. Most of us are good with recommending stable shoes and foot orthoses (of course from KevinRoot Medical), initially whether OTC or custom. Even simple varus wedges can be very effective at getting your biomechanical approach going on the first visit. Since we typically help patients by the 3rd or 4th visit with their shiny new foot orthotic devices and clean new stability athletic shoes (like the Brooks Addiction or New Balance 880), we can forget the next layer of treatment that I feel is essential and great biomechanics!
What are the components to this next layer of intervention? After stable shoes and orthotic devices, I love to recommend foot exercises that will help with pronatory patterns, and foot taping. The exercises are more long term help and the taping a short term need. I have to admit I had gotten lazy in the practice of foot exercises until the Barefoot Revolution hit the running market. I didn’t agree with most of their concepts, but I did agree I had to use strengthening to help my patients. I have seen the sometimes miraculous improvement in patients with exercises designed for their particular problem including hyper pronation syndrome. These exercises include: metatarsal doming, single leg balancing, posterior tibial and peroneus longus resistance bands, double and single heel lifts (aka calf raises), and glut min/med strengthening exercises. Tight achilles, medial hamstrings, and internal hip rotators should be stretched out. This can all be done with a Rx to Physical Therapy.
Now, the next layer of intervention to me is gait retraining as brought up by this article. Again, this is the role of the PT and not many of these specialists in gait exist in my area, but we must try.The key points of this article are:
- Widening the base of gait or the width of gait did decrease pronation
- Reducing the external angle of gait did significantly decrease pronation.
- Changing gait patterns to more lateral, or changing COP (center of pressure) laterally was also a good tool at decreasing pronation tendencies
- Changing from heel strike to forefoot strike is helpful at decreasing rearfoot pronation
- Asking the patient to land softer reduced pronation
The article summarizes their conclusions: “Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes.”
All in all, subtle changes are helpful for patients in reducing hyper pronation which can cause and aggravate injuries or pain syndromes. You can probably imagine that individual patients may be easier with one technique over another. Finding a good physical therapist interested in this field can really help your patients. Patients walk or run as they do, and some help from experts may be very beneficial. Rich
