Is foot pronation as bad as it seems?
Runners today must often travel to their nearest specialty shoe store for recommendations on the best footwear. Typically, after taking shoe size measurements, sales people will take the athlete through a gait analysis by either running across the sales floor or on an in-store treadmill. Sometimes, the runner is told they pronate and they’re guided to the best shoe on the market to counter such foot behavior.
Pronation is best described as the foot and ankle rolling inward, causing the arch to begin to flatten. Without pronation, the foot and ankle joint cannot effectively function, increasing the risk of injury. It allows the foot to correctly load forces and lets the big toe contact the ground for stability during weight-bearing activities. In return, the foot is in a neutral position and the big toe is evenly loaded to efficiently push off of the ground. In short, the foot lands slightly on the outside of the foot, pronates to a mid-stance position and then pushes off through the big toe. Imagine taking the recommendation of a stability or motion-control shoe, which would prevent the full normal motion of your foot. In fact, a study looked at 900 novice runners and found that a pronated foot was not to be associated with injury risk when wearing a neutral shoe.
Pronation becomes concerning when it becomes excessive. At this point, the arch is now entirely flattened. This excessive motion can lead to internal rotation of the shin and thigh (twisting inward) and this misalignment has been linked to a variety of injuries in runners, such as plantar fasciitis, Achilles tendonitis, medial tibial stress syndrome, and patellofemoral pain syndrome. These runners must be evaluated and may warrant specific shoe recommendations. But it would be wise to consider why this excessive pronation is occurring in the first place before leading someone toward a motion-control shoe.
A possible culprit of excessive pronation is calf tightness. Tightness of the gastrocnemius and soleus muscles can limit dorsiflexion, the motion of pulling your toes toward your shin. Consider the act of running. As your foot strikes the ground — whether rearfoot, midfoot or forefoot — the ankle needs to bend in order to push off. The tighter the calf musculature, the more difficult this motion, and the ankle collapses inward to allow the push off to occur. Here are some ways to work on calf tightness through foam rolling and stretches:
• Foam rolling gastrocnemius/soleus. In a long sitting position, place the foam roller under the calf muscle midway between your knee and ankle, and bend the other knee to approximately 90 degrees with your hands behind you for balance. Balancing on hands and one foot, keep the leg straight on the foam roller. Roll back and forth from knee to ankle.
• Gastrocnemius stretch. Put your left foot back and hands against the wall, keeping your knee straight. You should feel the stretch in your upper calf. Hold for 30 seconds and repeat on opposite side.
• Soleus stretch. Lean against the wall with your foot forward and bending your knee. You should feel the stretch in your lower calf. Hold for 30 seconds and repeat on opposite side.
In addition to calf tightness, it’s beneficial for the athlete to work on single-leg stability through a variety of hip strengthening exercises. The gluteus medius muscle found on the outside of the hip is primarily responsible for single-leg stability. If this muscle is not strong enough, internal rotation of the thigh will occur, the knee will turn inward and the foot will likely collapse.
Here are a few strengthening exercises to include in your training regimen:
• Gluteus activation. Put TheraBand loops around the legs — one just above your knees, and the other just above your ankles. Get into an athletic stance and externally rotate one of your legs 10 times while keeping your foot fixed on the ground. Repeat with the other leg, and then externally rotate both legs at the same time 10 times.
• Lateral TheraBand walks. Start by getting two TheraBands and position one above and around both knees and the other above and around both ankles. Get into athletic position. Start to step out to the side, making only small steps. Maintain proper squat form and lead with your hips, not reaching with your ankles/knees.
• Single-leg Romanian deadlifts. Stand on one leg with your arms out to the side and palms up. Have your knee slightly bent; do not lock your knee straight. Slowly lower your torso and lift your back leg in a single motion so that your torso and back leg are parallel to the ground. Squeeze your glute muscles and stand back upright.
Before assuming that new shoes will solve all problems, consider biomechanically why a runner is presenting the way they are. Of course, there are always orthopedic exceptions and a qualified individual, such as a sports medicine physician or podiatrist, should evaluate the athlete. However, a typical runner with no evident structural deformities may just benefit from some stretching and strengthening exercises to reach their goal of pain-free running.
Jen Morse, MS, CSCS, is the lead injury prevention specialist at The Micheli Center for Sports Injury Prevention. Learn more at www.themichelicenter.com.