Normal biomechanics of the foot and ankle include moving from supination to pronation and back during the gait cycle. This transition is necessary for proper shock absorption at heel strike, stability when the foot is flat and leverage for an efficient toe-off. The most common problem that interferes with effective foot biomechanics is excessive pronation. Since the timing of the change from pronation to supination is critical during walking and running, another term for this is "prolonged pronation." This condition occurs as a result of several factors, including loss of the medial longitudinal arch, eversion (tilting) of the calcaneus, or excessive dropping of the talus and/or navicular bones.
In addition to interfering with gait and decreasing athletic performance, excessive pronation is important for two major reasons. There is the likelihood of developing painful foot and ankle disability over time, and (especially important for doctors of chiropractic) the probability of transferring abnormal stresses up the lower extremity and into the pelvis and spine. Athletes may suffer from a number of "overuse injuries," which actually are caused by excessive pronation.1 Many times the developing problems go unnoticed for months or years, and it's only when a new walking or recreational program is begun that symptoms arise. Other times it is the painful end-stage of abnormal biomechanics which brings a patient in for care. Here's a review of the conditions and pathologies associated with excessive pronation.2
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Foot Conditions
It's reasonable to assume that abnormal foot biomechanics can lead to foot problems. What is unusual is the number of conditions which have been reported to be linked with excessive pronation. Table 1 is a list of the foot pathologies that have been identified.
Lower Leg Problems
Many of the muscles that move the foot and ankle and provide support during walking, running and jumping arise in the lower leg. Therefore, it makes sense that excessive pronation can result in various strains and tendinitisconditions of the lower leg. When abnormal biomechanics are combined with the higher forces of sports activities, even stress fractures can develop.3 Table 2 is a list of the commonly encountered conditions in the lower leg, associated with excessive pronation.
Knee Pathology
The knee is a hinge (ginglymus) joint, moving primarily in one plane. When excessive pronation at the foot and ankle causes increased medial rotation to transmit up the leg, this rotary motion eventually results in knee symptoms. Knee problems frequently develop in athletes who experience greater rotational forces.4 Some studies have even indicated that this can happen on an acute basis, causing rupture of the anterior cruciate ligament.5 Table 3 is a list of knee problems which can develop from excessive pronation.
Hip/Pelvis/Spine
Regretfully, there is much less written about the specific conditions of the hip, pelvis and spine caused by excessive pronation. Because the foot is not nearby, correlation of poor foot biomechanics with pelvic and spine problems requires additional research. The most important condition for doctors of chiropractic is the functional short leg, created by arch collapse and medial rotation of the ankle and leg. This results in a pelvic tilt to the shorter side and usually is accompanied by a spinal rotoconvexity (scoliosis). This is sometimes known as "functional scoliosis," since it is flexible and present only while in the standing position. Table 4 is a list of the pathologies which may be seen in the hip, pelvis and spine with excessive pronation.
Support From Toe to Head
Excessive pronation is associated with many musculoskeletal complaints - from the foot itself, up the leg to the knee, hip and even the pelvis and spine. The good news is that all of these conditions can be helped with flexible, custom-made orthotics. Investigation of foot biomechanics is a good idea in all patients, but especially for those who are recreationally active. Many times, correction of recurring subluxations can only be accomplished when an excessively pronating foot is provided with appropriate orthotic support. Competitive athletes must have regular evaluation of the alignment and function of their feet in order to avoid potentially disabling injuries. Preventive measures include wearing well-designed and constructed shoes and considering orthotic support in those patients at risk for developing excessive pronation.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
