Anyone who’s watched those OTC orthotic commercials (I’m gellin’!), has been to any running shoe store or read too many health magazines has been exposed to the evils of pronation and how it’s ruining our feet, our children, and society at large.  Over-pronators need control with a motion control shoe to prevent heel pain, tendonitis, knee pain, back pain, consumption, lethargy and hemorrhoids.  Under-pronators need cushioning to prevent… something.  Anyway, let’s try to separate the signal from the noise.

There are many different types of feet out there, and I love them all equally.  Some have flat feet, others have a very high arch, and some are just right, sort of.  During the gait cycle, the foot needs to be somewhat loose at some point, and locked at others.  As the foot makes contact with the ground it supinates, which means that the joints are somewhat locked, and stable.  This is the reason most people contact the ground on the outside of the foot, as reflected by the wear pattern in your shoes.  As the foot lands, it pronates, meaning the arch flattens and it becomes more loose in order to adapt to the ground surface and absorb the impact forces.  The heel then lifts, and at that point the arch is raised and the foot supinates once again to provide stability for the step.  This all happens within a fraction of a second, depending on walking speed.  It also occurs in all foot types – the high arched, the supinated foot, the low arched or the pronated foot.  So even over-pronators supinate at some point, and a very high arch, or supinated foot, will pronate at some point in the gait cycle.

So, after all that blah blah blah, what exactly does all this mean? Everybody pronates.  Just like everybody does all sorts of other things.  And like flat feet, it’s only a problem if it’s a problem.  Those who pronate excessively, as manifested by a flat foot, may actually be better long distance runners due to the shock absorption of the entire surface of the foot, while supinators tend to be better sprinters due to the spring action of the tripod like foot.  As far as the back pain, foot pain, leg pain and body pain that is caused by over pronating, like many other areas of medicine, there are many factors at play.  A very flat foot can potentially lead to leg and back pain, but not perhaps as much as a longer leg, which almost all of us have.  The bottom line is, if the foot is over-pronating, which can be broadly defined, and there is pain, it should be treated.  How?  Come on, kids you know that by now – with a custom orthotic.  And contrary to popular belief, orthotics can help the high arch, or supinating foot, by bringing the ground surface up to the foot and thereby distributing the pressure more evenly throughout the foot.

So if you pronate, and you probably do, fear not.  You are in good company.  And if your feet hurt, it’s probably your parents’ fault, like everything else.

See you in the office.

Ernest Isaacson

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Ernest L Isaacson DPM PC
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