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Plantar Fasciitis is the most common foot complaint and the main cause of heel pain, heel spurs and also arch pain. Millions of people suffer from Plantar Fasciitis, especially the over 50’s. Fortunately for 80-90% of Plantar Fasciitis sufferers there are some very effective treatment solutions available.

Definition:

Plantar Fasciitis (pronounced “plantar fash-eee-eye-tiss”) means litterally “inflammation of the plantar fascia”. Plantar Fasciitis is also called “Policeman’s Heel”. Plantar Fasciitis is often associated with calcaneal spurs (heel spurs).

Symptoms:

Plantar Fasciitis usually presents itself as a sharp pain, experienced at the underside or front of the heel bone. Often the pain is worse with your first steps when getting out of bed in the morning. For most people Plantar Fasciitis pain is more severe following periods of inactivity or rest, when getting up. After a short while the sharp pain subsides, turning into a dull ache. In the morning, stiffness and swelling in the heel area may be present.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You’re more likely to feel this after (not during) exercise and walking. Most people will put up with heel pain for at least 6 weeks before seeking (self)treatment, information and/or advice.

If Plantar Fasciitis is left untreated, it may become a chronic condition and treatment will become far more difficult. Also, Plantar Fasciitis sufferers tend to avoid putting weight on the sore heel and will try to walk on the forefoot in order to avoid pressure on the heel. With this abnormal walking pattern one could easily develop problems in the knees, hips or back.

Anatomy:

The Plantar Fascia is a thick, fibrous band of connective tissue that runs from the heel bone (calcaneus) along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough and resilient ligament structure that performs a critical function during walking and running.

The Plantar Fascia acts as a ‘bowstring’ connecting the ball of the foot to the heel. It forms the longitudinal arch of the foot and helps to lift the heel off the ground to prepare the foot for the ‘take-off’ (propulsive) phase of the gait cycle. During walking, at the moment the heel begins to lift off the ground, the Plantar Fascia endures tension that is around twice our body weight. The Plantar Fascia also act as a natural shock-absorber during walking and running.

Plantar Fascia

Causes of Plantar Fasciitis:

Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. This inflammation occurs at the point where the fascia attaches to the calcaneus (also known as the heel bone).

So what causes the Plantar Fascia to become inflamed? There are a number of various reasons for this to occur. For example, you are more likely to develop Plantar Fasciitis if you are over 50 years old, if you’re overweight, or pregnant, or if you have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you do a lot of walking or running for exercise (overuse injury). And if you have tight calf muscles (which a lot of people have) you’re also more likely to develop Plantar Fasciitis.

Research has shown, however, that the number 1. cause for Plantar Fasciitis is over-pronation (or fallen arches).

Over-pronation of the feet is very common, at least half of the population has this problem, but most people don’t realise they have this condition! Over-pronation simply means that the feet and ankles roll inwards too much during walking and that the arches collapse. With age, most people tend to over-pronate. However, this condition is not uncommon in children and teenagers, as well as athletes.

When the arch collapses the 2 outside points of the bow (being the heel and ball of the foot) are being placed farther away from each other. This puts repetitive stress on the Plantar Fascia. The attachment of the fascia into the heel bone is a tiny area of tissue, compared to the wide attachment area to the toes. Therefore, the constant excess pulling on the fascia will do damage to the weakest attachment point.

Over time irritation occurs at the heel bone, followed by inflammation and micro-tearing of the plantar fascia tissue. Sometimes swelling is present. If the pulling continues the heel bone will ‘respond’ and a bony growth will develop on the front of the heel bone. This is referred to as a ‘heel spur’. Interestingly, the heel spur itself doesn’t cause any pain, but the inflamed tissue around it does.

Plantar Fasciitis Treatment options:

Fortunately, most cases of Plantar Fasciitis can be treated effectively at home. Firstly, you need to refrain from activities that cause pain such as long walks, running, sports and standing for long periods. Rest allows any swelling, inflammation and/or pain to subside.

Applying ice (or a heat pack) to the heel area and using anti-inflammatory pain killers like Advil or Nurofen (both contain ibuprofen) will provide immediate pain relief.

However, long term, effective treatment of Plantar Fasciitis consists of a simple program of daily stretching exercises, combined with wearing an orthotic to support the arches.

Gentle stretching of the Plantar Fascia, the Achilles tendon and the calf muscles will all help making your feet and a lot more flexible, which in turn will help reduce the exessive pulling of the Plantar Fascia. Do the stretches fist thing in the morning and avoid walking barefoot on hard floors and tiles. Instead, slip on a pair of shoes with an orthotic inside them. Repeat the exercises (especially the calf stretches) a few times during the day.

You can find the complete Plantar Fasciitis stretching exercise program here. Or talk to your physiotherapist or podiatrist about specific exercises. Sometimes practitioners will prescribe a night splint, designed to gently stretch the fascia during the night.

With the combination of daily exercises and orthotics you will see a major improvement within a few weeks. If you are overweight, it is recommended to lose some weight as this will reduce the strain on your feet.

In cases where the pain persists, or is severe, Plantar Fasciitis can be treated with a cortisone-steroid injection into the heel. However, this is only a short term fix and the pain will return within 3 months. A newer treatment for Plantar Fasciitis (instituted prior to surgery) is electrocorporeal shock wave therapy. In this procedure, an instrument administers pulses of energy (shock waves) to your heel to relieve pain.

Surgery for Plantar Fasciitis is rarely required, unless all other treatments have failed to relieve the pain. Surgical procedures include removing a portion of the Plantar Fascia.

Plantar Fasciitis and Orthotics

Research in America, Europe and Australia has clearly proven that wearing an orthotic insole is the best way to treat Plantar Fasciitis, especially when combined with daily exercises. However, it must be noted that this treatment regime is mostly effective for people who have started to notice heel pain recently (i.e. no longer than 6-8 weeks ago) or for people who only suffer mild Plantar Fasciitis pain.

The reason an orthotic works is simple: the cause of Plantar Fasciitis is the constant pulling of the “bowstring” under the foot, because of the lowering of the arches. Orthotics prop the arches back up, thereby reducing the excessive tension on the plantar fascia.

With less tension on the plantar fascia, the damage to the ligament can be reversed. The tissue is allowed to heal faster and repair the micro-tearing, which has occurred at the heel bone attachment.

The orthotic will be even more effective when worn in a pair of good, supportive shoes. I.e. a shoe with a strong back (heel counter), stabilising the heel and ankle joints during walking and running.

There are different types of orthotics, including custom-made ones from a Podiatrist. However, not everyone will need a custom-made device. Nowadays, good supportive and inexpensive orthotics are available from retailers and specialty websites. The main factor is support, more so than cushioning. So don’t buy a soft, spongy or gel footbed, but rather an insole with a high arch, made of reasonably firm materials.

Tips for preventing Plantar Fasciitis

Correcting some of the pre-disposing factors will ensure Plantar Fasciitis doesn’t re-occur, for example:

1. lose some weight if needed: this will reduce the physical load placed on the Plantar Fascia during walking

2. wear good quality, supportive shoes: i.e. shoes with a strong heel counter and with good flexibility in the front of the shoe (that allows the toes to bend back easily and naturally). Don’t wear completely flat shoes. A raised heel helps reducing the tension in the plantar fascia.

3. try to avoid walking barefoot on hard surfaces (including hard sand on the beach)

4. when exercising (walking, running or sports) always stretch your calf muscles first. Greater flexibility in the tissue makes them less susceptible to damage.

The most common cause of heel pain and heel spurs is a condition called Plantar Fasciitis (sometimes misspelled Planter Fascitis). This is Latin for inflammation of the Plantar Fascia. The Plantar Fascia is the broad band of fibrous tissue that runs under the foot and that forms your arch. Because of a number of different factors the plantar fascia are being overly stretched and this continuous pulling results in inflammation and pain at the heel bone, at the point where the ligaments insert into the heel bone.

Over-pronation of the feet (fallen arches + rolling inward of the feet and ankles), tight calf muscles, as well as ageing and being overweight are the main causes for the plantar fascia being overly stretched.

There are many ways to treat heel pain, heel spurs and Plantar Fasciitis, including cortisone injections and surgery. However, in most cases heel pain relief can be achieved through self-help by following a number of easy, simple steps, most of which are aimed at reducing the pulling of the plantar fascia:

1. Rest, reduced activity:

When you have heel pain avoid any activity that can further aggravate the problem. This includes walking for long distances, walking up or down stairs, running, sports etc. If you want to keep fit swimming is the safest activity, until your heel pain has been treated properly. Or you can ride a bike or a stationary exercise bike. Basically, try to be as little on your feet as possible, allowing the plantar fascia to heal itself.

2. Ice (combined with heat)

Use an ice pack and apply it onto the sore heel for 5-10 mins at a time, 3 to 4 times per day. The ice will reduce the inflammation in the heel area. To help reduce any chronic inflammation, you can try alternating between ice and heat. Place an ice pack on the heel for 5 minutes and then switch to a hot pack (or hot water foot bath) for another 5 minutes. Do this for about 20-30 minutes per day and you’ll notice some considerable heel pain relief.

3. Roll a tennis ball (or rolling pin) under the foot

Many people with Plantar Fasciitis experience a sharp heel pain in the morning, when taking the first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching and massaging the plantar fascia before standing up will help reduce heel pain for the rest of your day! Massaging the plantar fascia can be done simply by rolling a tennisball (or rolling pin) under the foot, all the way from the heel to the toes. You may do this sitting down, applying a fair amount of pressure onto the arch, or even standing up as long this causes not too much discomfort. Keep rolling the ball or pin under the foot for about 5 minutes.

4. Stretch your feet with a towel

Stretching the plantar fascia is your next heel pain exercise, using a bath towel. Put a rolled up towel under the ball of one foot, holding both ends of the towel with your left and right hand. Next, slowly pull the towel towards you, while keeping your knee straight (the other knee may be bent). Hold this position for 15 to 20 seconds. Repeat 4 times and change to the other foot, if necessary. (It’s always good to do these exercises on both feet, even if you only experience heel pain in one foot, as this will help prevent the heel problem to come back in your other foot!)

5. Stretch your calf muscles

This is the last morning exercise and won’t take long.  Stand facing a wall with your hands on the wall at about eye level. Put one leg about a step behind your other leg, keeping your back heel flat on the floor. Make sure this leg stays straight at all times. Now bend the knee of the front leg slowly, lowering your body until you feel a stretch in the calf of the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times. Do the same for the other leg.

Now you’re ready to face the day! Please make sure you don’t walk barefoot at home in the morning, as this will undo all the hard work. Wear shoes or supportive sandals as soon as you have done the heel pain exercises.

You can repeat any of these heel pain exercises during the day, if you wish. For example the tennis ball rolling can be done as you watch TV or read the paper. 

There’s one more exercise you may want to do which is called the Achilles Tendon stretch. Stand on a step with both feet on the same step and slowly let your heels down over the edge of the step as you relax your calf muscles. Hold this stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 4 times.

Please note that stretching exercises should create a pulling feeling, they should never cause pain! 

6. Take an anti-inflammatory drug, like Ibuprofen

To ease your heel pain you can take an anti-inflammatory that contains Ibuprofen, like Nurofen or Advil. This is a short term fix that will help decrease the inflammation of the plantar fascia. You still need to do take all the other measures such as stretching, ice, orthotics etc to achieve long term pain relief from your heel problem. For many people Ibuprofen is pretty heavy on the stomach and therefore these drugs should be taken in moderation.

7. Lose some weight

As we get older we tend to put in a bit of extra weight. The combination of weight gain and ageing means we put a lot of extra tension on our muscles and ligaments in the feet, legs and back. Most people tend to over-pronate because of weight gain. Over-pronation (fallen arches) is the main cause of Plantar Fasciitis and heel pain. Therefore by losing weight you will decrease the tension on the plantar fascia.

8. Wear the right footwear

Supportive footwear is paramount, especially as we get older. Floppy footwear causes ankle instability during walking and contributes to the problem of over-pronation, leading to heel pain and other foot problems. A good supportive shoe should only bend at the sole in the forefoot area and should be firm elsewhere, especially the back section of the shoe (heel counter) should be firm. Many footwear companies advertise shock-absorption and cushioning as the major benefits of their (sports) shoes. Stability is far more important than cushioning! 

9. Use a night splint

A night splint holds the foot at 90 degrees during your sleep. The aim of the splints is to keep your foot and calf muscles stretched during the night. Normally during rest the plantar fascia and calves tend to tighten and shorten. So when you wake up in the morning and take your first steps, the fascia are being pulled all of a sudden, causing the sharp pain in the heel. 

The problem with night splints is that they can be quite uncomfortable. This is why they are so-called sock night splints on the market which are more bearable than rigid night splints.

10. Wear orthotics in your shoes

Research has shown that by far the most effective way to treat heel pain, plantar fasciitis and heel spurs is wearing a corrective device inside the shoe. Orthotics are designed to correct the problem of over-pronation, the major cause of plantar fasciitis and heel pain. Orthotics support the arches and control abnormal motion of the feet, thereby greatly reducing the tension in the plantar fascia band. Especially when combined with daily exercises, orthotics will provide relief to the majority of heel pain sufferers. 

Orthotics can be obtained from a foot specialist (podiatrist). These are called custom orthotics and they usually quite hard. Nowadays there are softer orthotics on the market, which are made of EVA and which mould themselves to the wearer’s foot shape because of body heat and body weight. These softer orthotics are pre-made and available without a prescription from pharmacies and specialty websites.

This article sheds light on a very common type of foot pain called Metatarsalgia, more commonly known as ‘Ball of Foot Pain’.

Metatarsalgia – Ball of Foot Pain  - introduction

Pain in the balls of the feet (Latin: Metatarsalgia) is a very common foot complaint, in particular for women. Most women who wear high heels or tight fashion shoes (or who have done so in the past) are likely to suffer from Metatarsalgia. Men can also suffer from this condition, especially if they have to wear hard shoes or boots without any cushioning inside, and their job requires standing or walking for prolonged periods. For example workboots or military/police boots can easily cause ball of foot pain.


What are the symptoms of Ball of Foot Pain?

People suffering from Metatarsalgia often experience a burning sensation under the ball of the foot. Sometimes combined with a sharp, tingling sensation near the toes (this condition is called Morton’s Neuroma, see further below). The pain can also be stabbing pain that comes and goes throughout the day. In some cases people experience a feeling similar to having a pebble sitting under the forefoot.

Ball of Foot pain worsens when wearing high heels/fashion shoes for a longer periods of time or, for men after walking long distances in hard shoes. Typically people with Ball of Foot pain also display excessive callous formation under the balls of their feet. 

Ball of Foot Pain – Metatarsalgia

What causes Metatarsalgia?

Typically, the two main causes for ball of foot pain are:

- wearing high heels/fashion shoes

- over-pronation (fallen arches)

Most (young) women like to look stylish and wear a shoe with a medium to high heel. The problem with high heels is that your bodyweight is not evenly distributed across the underside of the foot, but rather 80% of your weight pushes down on only one area of the foot, the forefoot area. i.e. the balls of your feet. This is totally unnatural and before long the entire forefoot structure collapses, leading to constant pressure and friction in the ball of the foot. The body reacts and builds up thick layers of callous in this area which in turn leads to a burning sensation under the foot.

Also, as part of the ageing process women tend to lose the bulk of the shock-absorbing ‘fibro-fatty’ pad under the ball of the foot. Without this natural padding pain develops due to the pressure on skin over bone.

Another cause of Ball of Foot Pain is over-pronation. Over-pronation (or excess pronation) occurs in a lot of people, especially as they get older. The arches drop and feet and ankles tend to roll inwards. Excessive pronation is a major contributing cause to heel pain and heel spurs, but it also can lead to Metatarsalgia. As the longitidunal arch collapses so does the transverse arch. The transverse arch is the arch that runs across the forefoot and is formed by the 5 metatarsal bones. The bones in the foot drop and the structure of the foot is severely weakened. When we wear shoes that do not provide enough support and cushioning excess pressure is placed on the ball of the foot and often pain is experienced. 

Over-pronation, combined with wearing hard, flat shoes and walking on hard surfaces such as concrete, pavements, tiled floors etc often leads to ball of foot pain, but also other common complaints including aching legs, knee pain and lower back pain.


Treatment of Ball of Foot Pain (Metatarsalgia)

For ladies’ high heel and fashion shoes there is a new, unique solution to ball of foot pain: Footlogics ‘Catwalk.’ Made in Spain these specially designed insoles restore our natural body balance by supporting the longitundinal arch, as well as the metatarsal bones and they shift bodyweight away from the forefoot towards the arch and heel. The result is that your bodyweight is more evenly distributed over the entire surface of the feet, and not just pushing into the balls of the feet. Thus, the insole prevents excessive pressure and friction in the ball of the foot are, and greatly reduces/eliminates the pain and burning sensation under the feet – especially with longer periods of standing or walking.

In case of regular flat footwear – whereby Metatarsalgia is caused by over-pronation –  a full-length orthotic insoles with arch support as well as metatarsal support is recommended to prevent and relieve pain the ball of the foot.

Removal of excess callous by a Pedicurist, Chiropodist or Podiatrist is highly recommended to relieve ball of foot pain. You can also remove hard skin and callous yourself by means of daily light abrasion (using a pumice stone or fine grit foot file).

Choose the right footwear..

Shoes that are very narrow in the forefoot force the metatarsal bones together, pinching nerves and blood vessels that run between the bones. Continued use of shoes that are too narrow can cause one or more of the metatarsal bones to either shift up or down within the transverse arch, causing the arch to completely collapse.

On the other hand, shoes that are too wide can cause shearing stress under the foot as it slides around, causing callus to build up under the ball of the foot and under the toes. A narrow foot in a wide shoe will slide forwards, causing compression and curling of the toes. By allowing your toes to curl inside a shoe, you disturb the resting positions of your extensor and flexor muscles. Over time, this can result in fatigue and even cramp.

Thin soled shoes or shoes without any innersole cushioning will transfer all the hard impact with man-made surfaces directly into the bones of your feet, stimulating callous formation. So always buy shoes with plenty of cushioning and support, or wear orthotics inside your shoes.

Ill-fitting footwear should be replaced by anatomically correct, well-balanced and cushioned shoes. Avoid the use of high-heeled shoes or only wear high heeled shoes for no more than a few hours per day.

If problems persist, please consult a podiatrist.

Related articles:

Morton’s Neuroma (Ball of Foot pain and Tingling sensation/numbness in the toes)

Sesamoiditis

“The foot bone is connected to the leg bone, the leg bone is connected to the hip bone, the hip bone is connected to the back…”

The old saying is true. A number of recent studies have shown how the position of our feet and walking pattern affects the rest of the body. Simply put: if your feet are out of alignment your entire body could suffer the consequences. It’s not much different from a tall building with with damaged foundation or if you will a card with bad wheel alignment…

As a result of poor alignment of the feet, you may experience aching legs, knee pain, even low back pain. Not surprisingly, the most common foot problems such as heel pain, heel spurs, plantar fasciitis, Metatarsalgia, Achilles Tendonits etc are all directly linked to poor foot function.

Foot orthotics are devices that you wear inside your shoes to correct a bad walking pattern and also to improve body posture. Orthotics will help relieve not only foot pain, they also assist with shin splints, knee and back pain. This article explains what precisely an orthotic device is, how they work and the different types of orthotics that are available.

What precisely is an ‘orthotic device’?

An orthotic device or orthotic is a generic name for corrective insoles and shoe inserts (also called Orthosis) that are placed inside the shoe to correct and restore the natural function of our feet. Faulty foot biomechanics contribute to many common conditions including as heel pain, knee pain, and lower back pain.

Biomechanics is the Science of Movement – it studies motion during walking, running, and sports.

Exessive pronation is the term used most when referring to poor foot biomechanics. It means that the arches in your feet collapse or flatten while the feet and ankles roll inwards. Podiatrists estimated that around 70 percent of the population suffer from excess pronation. Orthotics are designed to correct over-pronation by restoring the feet and ankles to their natural position, required for natural foot functioning. Orthotics not only help alleviate foot problems, they also help prevent future problems and injuries.

What are the different types of orthotics available?

Generally speaking there are three different types of orthotics. These are:

A) Custom-made (rigid/hard) orthotics

For patients with serious biomechanical disorders custom-made (rigid) orthotics provide the appropriate solution. 

These devices are prescribed and fitted by podiatrists. People who suffer from foot deformities like large bunions, foot ulcers or completely flat feet are often prescribed a functional orthosis. Also patients with a very high arch and rigid feet (Pes Cavus) can benefit from a custom orthotic. After initial diagnosis the podiatrist decides the patient requires a pair of custom orthotics. Next, a plaster cast of the patien’ts foot is taken (i.e. a negative impression of the feet) after which the cast is sent to an Orthotic Fabrication Lab. From this mould a positive impression is formed by pouring plaster into the mould and the result is an accurate copy of the underfoot. The Orthotist (Orthotic technician) fabricates the custom orthotic and will add some adjustments and wedges as instructed by the podiatrist. Even though custom orthotics are very useful devices many patients find the use cumbersome and often they do not easily get used to the orthotic, because they are very hard under the arches.

B) Heat-mouldable orthotics

Heat-mouldable orthoses are a cheaper alternative to expensive custom rigid orthotics that can cost $400 – $600 per pair. They are standard ‘off-the-shelf’ more flexible devices, made from high density EVA materials. The device is heated to slightly alter its shape. Sometimes, wedges are added for a more customised result. Heat-mouldable Orthotics cost around $100 to $140 and are much easier to get used to than custom rigid orthotics. Many physiotherapists and chiropractors now use heat-mouldable orthotics in their clinic.

C) Pre-made ‘over the counter’ orthotic:

Pre-made (or pre-fabricated) orthotics are soft to medium density flexible shoe inserts available from pharmacies, on-line specialist websites, and also from some physiotherapists or chiropractors. No prescription is necessary for pre-made orthotics. One will get used wearing these devices almost immediately and the cost ranges from only $30 to $60 per pair. Research has shown that for most people suffering from over-pronation, a pre-fabricated orthotic will provide sufficient correction and support to help alleviate common foot problems. After a few weeks of wear pre-made orthotics will customise to the wearer’s foot shape as a result of their body weight and body heat. Most pre-fabricated orthotics are made from EVA, a flexible material that supports the foot without hurting the arches. Especially children and elderly people benefit from a softer type of orthotic since they cannot tolerate anything hard under the foot.

What is the difference between orthotics and regular cushioning (gel/rubber) footbeds?

There is a big difference between cushioning footbeds and orthotics! Regular footbeds are quite flat and only designed to provide a cushioning and shock absorption. At first they may feel comfortable however these footbeds do not address any biomechanical issues and they do not correct the problem of over-pronation. Whereas orthotics are functional devices designed to correct and optimise our foot function. Some footbeds may feature a slight arch support but not steep enough to have any appreciable effect. This is especially true if the materials used are very soft and rubber or gel-like.

How do orthotics work?

Orthotics do a lot more than just supporting your arches. They stabilise the foot and ankle, re-align the feet and restore faulty foot function. Additionally, orthotics provide an even weight distribution and take the pressure of sore spots from heels, ball of the foot, corns and between toes, and bunions. Orthotics also support the transversal arch of the foot. I.e. the arch that runs across the forefoot, formed by the metatarsal bones. As a result of excess pronation, the forefoot structure tends to collapses, which means the metatarsal bones drop, causing problems in the ball of the foot.

Though it is not their main purpose, the orthotics do provide some degree of shock absorption as well, especially the softer pre-made orthotics. The main purpose of an orthotic insole is to improve our foot function and for most people orthotics will reduce pain and will help prevent future problems and injury.

There have been suggestions by some that the use of orthotics may weaken the foot muscles. According to a recent research paper from Australia “there are no reasons to doubt any decrease in muscle activity even after four weeks usage. Therefore foot orthoses users may not be worried through these unsupported statements.”

What are the typical complaints which orthotics be used for?

Years of use and prescription have proven that most foot complaints will respond favourably to treatment with foot orthotics. These devices are found to be very effective in the treatment of heel pain, heel spurs, Plantar Fasciitis, pain from bunions, callous and corns, Achilles Tendonitis, ball of foot pain, Metatarsalgia and also Morton’s Neuroma.

Our feet are the foundation of our body. Many problems in the legs, knees and back can be attributed to faulty foot biomechanics. Therefore, orthotics have been proven very useful in the treatment of shin splints, knee pain and lower back pain. This is the reason that many (sports) physiotherapists and chiropractors have started using orthotics. Over-pronation of the feet is the cause for the lower leg to rotate inwards and the pelvis to  tilt forward, in turn putting a lot of stress on the legs, knees and back. Orthotics corrects the problem of over-pronation and therefore greatly reduce internal leg rotation and forward pelvic tilt, thus helping to relieve lower back pain. A study from the USA “identified the nature of a person’s walk as a source of chronic lower back pain”. The study further showed more than a fifty percent improvement in alleviation of back pain after wearing orthotics!

Sources: 

Vol. 94 Number 6 542-549 2004 Journal of American Podiatric Medicine 

The Journal of American Podiatric Medicine May 1999, Sobel E, Levity S T, Caselli MA Division of Orthopedic Sciences,New York College of Podiatric Medicine

“Chronic Low-Back Pain and Its Response to Custom-Made Foot Orthoses” HOWARD J. DANANBERG, DPM, MICHELLE GUILIANO, DPM

”The Conservative Management of Plantar Fasciitis”- Pfeffer GB , University of California, San Francisco, CA.

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Most foot problems, as well as knee and lower back pain stem from over-pronation of the feet. Over-pronation is the collapsing of the arches and rolling inwards of the ankles. Over-pronation is most common with people who are overweight. Simply put the bone structure in the feet is designed to carry your normal, natural weight, not an extra 10 or 20 kilograms!

To prevent common problems such as heel pain, ball of foot pain, aching legs, knee or back pain weight loss is essential. For many losing weight on your own is not that easy. Motivation, advice and guidance are the keys to a successful weight loss program.

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Pronation and supination are commonly heard terms, often in association with fallen arches, high arches, flat feet etc. This article explains the meaning of these terms and looks in particular at the problem of over-pronation. You will read about the following:

1) What do the terms Pronation and Supination mean?
2) What exactly is over-pronation?
3) What are the consequences of over-pronation?
4) What can we do to fix the problem of over-pronation

What do the terms ‘Pronation’ and ‘Supination’ mean?

To understand the terms ‘Pronation’ and ‘Supination’, firstly we need to look at the gait cycle – that is the way we walk, or our ‘walking pattern’.

The gait cycle is broken down into 3 different phases:

1) Contact phase: Firstly the outside of your heel hits the ground. This is entirely normal and it’s the reason why most people’s shoes wear out faster on the outside heel area of the soles. Just after the heel strikes, pronation occurs. I.e. the foot flattens out and the ankle rolls inwards. At the same time, your lower leg rotates inwards from the knee down. The pronated foot is flexible and loose, allowing it to adapt to the ground you’ve just stepped on. Pronation is your natural ‘shock-absorbing mechanism’.

This contact phase continues until the foot is completely flat on the ground.

2) Midstance phase: The foot is flat on the ground and in this part of the gait cylce your body weight passes over your foot as the body comes forward. This is where your foot supports your body weight. The midstance phase is the part of the gait cycle where an abnormally functioning foot such as an over-pronated foot (fallen arches) or an over-supinated foot (high arch foot) will manifest its problems.

This phase ends as your body weight passes forward eventually forcing your heel to rise off the ground. At this stage supination occurs and the opposite to pronation happens: the muscles tighten and the foot becomes a rigid lever for the leg muscles to pull against. Rigidity in the foot should occur as the foot is propelled forward towards the next step. With supination, the foot rolls outwards and the lower leg rotates externally.

3) Propulsion phase: this is where the foot pushes off the ground to propel the body forward. Body weight is picked up by the ball of the foot and lastly the weight is absorbed by the big toe as you push off with that foot.

It is important to understand that both pronation and supination are part of a normal, healthy walking pattern! Pronation (rolling inward) acts as a shock absorbing process and supination (rolling outward) helps to propel our feet forward.

What exactly is over-pronation?

Over-pronation occurs when we pronate too deep and for too long, not giving the foot a chance to ‘recover’ and supinate. The foot stays flexible at all times. Over-pronators use a lot more energy when walking. Worse, over-pronation causes an imbalance throughtout the entire body, putting excessive strain on the feet, legs, knees and lower back.

Other terms for over-pronation are ‘fallen arches’, ‘dropped arches’ or ‘collapsed arches’. The term ‘flat feet’ is also often used. However, a true ‘flat foot’ is very rare. In fact, less than 5% of the population have completely flat feet (Pes Planus) with no arch present whatsoever. Most of us (90%) have a normal to low arch and only 5% have a high arch. People with a high arch (Pes Cavus) are also called ‘over-supinators’. This means that the foot stays rigid at all times and lacks its natural shock-absorbing mechanism.

It’s important to appreciate that you don’t have to be flat-footed to suffer from over-pronation! In fact, the vast majority of people with a ‘normal- to-low arch’ suffer from over-pronation. Interestingly, the arches may appear quite normal when sitting (or even standing up-right), but when we start to walk the problem of over-pronation becomes evident…with every step we take the arches collapse and the ankles roll inwards.

Over-pronation can be caused by a number of factors. Weak ankle muscles, being over-weight, pregnancy, age or repetitive pounding on hard surfaces (like pavements and concrete floors) can all lead to over-pronation. Over-pronation is also very common with athletes, especially runners.

What are the consequences of over-pronation?

Whether you have a true flat foot or have a normal-to-low arch and suffer from over-pronation (like 70% of the population), in both cases your poor walking pattern may contribute to a range of different complaints.

Many people over-pronate, however there are no clear symptoms, no aches or pains or complaints – especially in younger people (under 40’s).

When people reach 40 or 50, poor foot function will start to show and over-pronation will take its toll. Many years of over-pronation will result in wear and tear in the feet, ankle and knee joints and lower back. People will simply accept these common aches and pains as a sign of ageing. Very few people realise these complaints have a lot to do with their fallen arches!

So what are the most common complaints related to over-pronation?

Plantar Fasciitis is a very common condition caused by over-pronation. As the feet flatten, the Plantar Fascia (fibrous band of ligaments under the foot) is being overly stretched, leading to inflammation in the heel, where the fascia attach to the heel bone. Plantar Fasciitis causes chronic heel pain and sometimes a heel spur develops (bony growth at the heel bone).

With over-pronation the foot continues to roll inwards, when it should be pushing off and outwards. When the foot rolls inwards the lower leg will follow and rotate internally and stay in this position (instead of rotating externally with supination).

This puts a lot of strain on the leg muscles (especially the calf muscles), causing aching legs and shin splints. Also, the twisting of the lower leg displaces the patella (knee cap). The knee is a hinge joint, designed to flex and extend (like a door, if you like). It’s not designed to rotate! Over-pronation is therefore a major contributing cause of knee pain.

Furthermore, when the legs rotate inwards the pelvis is forced to tilt forward. This results in constant strain and stress on the lower back muscles, causing back pain.

What can we do to fix the problem of over-pronation?

There is no real cure as such for over-pronation, however a lot can be done to prevent it. The most effective way to minimise over-pronation and its effects on the body is by wearing orthotics inside the shoes.

An ‘orthotic’ (orthotic insole, shoe insert or orthosis) is a device placed inside the shoes with the purpose of restoring our normal foot function. Different types of foot orthotics are available, from special custom-made devices (prescribed by a Podiatrist) to so called ‘off-the-shelf’ orthotics which can be purchased from pharmacies, good quality shoe stores or specialty websites.

Orthotics correct the problem of over-pronation and they re-align the foot and ankle bones to their neutral position, restoring our natural foot function. In turn, this will help alleviate problems not only in the feet, but also in other parts of the body!

In addition to wearing an orthotic, it is recommended to wear supportive shoes with some degree of built-in ‘motion control’.

Motion control shoes incorporate support features into the shoe. Shoes with adequate arch support and firm heel counters help control over-pronation and will stabilise the heel and ankle during walking. Some shoes also have side posts for extra lateral support. Firm midsoles reduce pronation and protect the ankles and knees from lateral stress. The inner side of the midsole may be made of a denser material (dual density midsoles) to reduce the amount of pronation. A heavy person who overpronates will need a heavier, more supportive shoe than a light person with the same degree of pronation.
Too many shoes these days are using soft materials all-around the shoes and are very ‘floppy’ giving no support or stability whatsoever. In summer, many people wear open footwear such as sandals and flip-flops which are even worse in biomechanical terms.

Read more about over-pronation and the different treatment solutions available.