What is pronation of the foot?

 

Have you started to feel that one of your feet keeps rolling in when you run? Or blisters start appearing on the inside of your foot for no apparent reason? Usually people put it down to their shoes, however that may not be the cause. It may be down to over-pronation.

Foot pronation is normal. It is part of a shock absorbing mechanism that helps prevent injury or trauma to the foot, ankle and leg. When your heel hits the floor the heel moves outwards slightly and your ankle rolls in slightly. This helps you to adapt to different surfaces when running, walking and jumping and is completely normal. The issue lies with over pronation. Over pronation is a compensatory movement caused by an incorrect relationship between the foot, heel, leg and hip.

It is worth mentioning that some people are naturally flat footed or have naturally dropped arches, in this instance if there is no pain you may not need to address having a slight over pronation. Issues usually arise when you previously had higher arches that have now dropped, or become dropped when you put weight through your foot; leading you to become more flat footed.

Foot pronation

 

What is the actual cause of over-pronation?

The latest research suggests many injuries throughout the body can actually stem from having weak hips, including over-pronation.

Specifically in the case of over-pronation, the gluteus medius being weak/weaker than it should be. The gluteus medius is located underneath the gluteus maximus and is a primary hip abductor muscle. It’s role is to provide stability to the hip and knee whilst walking, running, jumping and squatting. Weakness in this muscle can be associated with lower limb musculoskeletal injuries such as ankle and knee pain to name a few.

 

gluteus

 

Spotting the weak link

There are several tests that can be carried out to determine if you have weakness in your gluteus medius which could be resulting in over-pronation of the foot.

The Trendelenburg sign is when the muscle is unable to work efficiently due to pain, poor mechanics or weakness. The pelvis will drop on the opposite side to the weakness. This is your bodies compensation that’s often observed with a Trendelenburg gait (weakness of abductor muscles).

If this imbalance is not addressed, it can lead to more serious and additional issues such as knee and hip pain and other lower limb injuries. The sooner you can address an imbalance, you can either; prevent it from becoming an issue in the first place or get back to full fitness quicker and spend less time resting and rehabbing. You can book in with one of our specialists here.

 

Spotting the weak link

 

Side lying strength assessment

(with help from a practitioner)

Start by lying on your side, bring your top leg forward slightly, and internally rotate the upper most hip whilst performing hip abduction (lifting your leg up and away from the other leg).

A score between 3 and 5 is given for; abducting against gravity, abduction against gravity plus moderate resistance, and abduction against gravity plus maximum resistance.

Side-lying strength assessment

 

Exercises to help strengthen the weak link

 

Side lying abduction

Start position: Lie on your side with your head supported, knees straight and feet together.

Action: Lift your top leg off your bottom leg as high as possible without rotation of your pelvis (keep your knee facing forward). Then return to start position.

Key points: Ensure your pelvis does not rotate backwards using the lift.  If the muscle weakness is in the right gluteus medius, lie on your left side so your right leg is on top.

 

Side lying abduction

Clam

Start position: Lie on your side, and rest your head on your arm. Bend your legs so that your hips to approximately 45 degrees and bends your knees at 90 degrees.

Action: Take a deep breath in and as you exhale activate your core muscles. As you’re exhaling move your upper leg up and outwards while keeping your feet in contact with one another. Then inhale, and as you exhale bring the leg back down to the starting position.

Key points: When you’re in the starting position make sure one hip is lying above the other, and concentrate on activating your core muscles during this exercises. If the muscle weakness is in the right gluteus medius, lie on your left side so your right leg is on top.

This exercise can be completed for as many reps as you can sustain. You can add a resistance band to make it harder.

Clam

Banded walks

Start position: Place a resistance band just below your knees. Begin standing with feet directly under neither your hips, and bend your knees so you are in a half squat.

Action: Take a step sideways to the right as far as you can, keeping tension in the band at all times. To fully activate the muscle – be sure to step onto your heel, rather than your toes. Then actively resist the pull of the exercise band as you bring your left leg slowly towards your right, retuning to the starting position.

This exercise can be completed 10 steps to the right and 10 steps to the left.

Key points: Maintain constant tension through the band, ensure controlled movements when stepping to the left and right.

Banded walks

Aim for 2-3 sets of 10-20 reps of each exercise.

Please remember that not all exercises work for everybody. If any pain is felt during these exercises please stop and seek medical advice.

If you feel you need guidance or advice regarding any muscle weakness or lower limb injury please don’t hesitate to book in with one of our practitioners today – Click here.

All of our therapists here at Comfort Health are well trained in muscle imbalances and the resulting injuries. They are all also frequent runners and understand the importance of running at full health.