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Is Pronation Bad?

25 Sep 2014
James Pope
Is pronation bad? Clinically we get presented with some tricky situations, the one I think we have all been in is what to do when someone presents with asymptomatic flat feet and many questions about this term “pronation”. We have all heard of the term “pronation” it certainly has a hard time making friends in the running world and I have always wondered how well we understand it.

Pronation is the movement of the foot as it contacts the ground; working to absorb the impact forces of landing, if we think about this movement for a second I think we can all appreciate how important it is. Imagine for a second we are jumping off a step, to decrease chance on injury we do a number of things without thinking: bend our knee, land on our forefoot and use our ankle joint. Ideally we also want our foot to move as well, and with 26 bones in each of them we certainly expect these joints to bend and give to absorb the shock.

Looking to the literature we are continually trying to find out if pronation, or more specifically excessive pronation causes injury. The issue is how do we actually quantify the excessiveness of this required movement.  Deydre et al found that with excessive pronation we see an increase in lower limb injuries from the knee to the hip. There have also been studies linking a pronating foot to causes of anterior knee pain. But as much evidence I find for excessive pronation being an issue it can all be rebutted with the opposite opinion as Neilson et al showed.

So what should we be thinking? 

I think it comes down to more than just over pronation, sure it can be a huge issue, any excessive movement of multiple joints can be seen as a potential injury threat, but for someone with good soft tissue adaption techniques and good loading patterns it doesn’t need to be. If we see it to be an issue and there is evidence of injury then we can look to protect the injured tissue with interventions such as footwear, orthotics, load management and strengthening, as for any injury these are mandatory considerations.

Excessive pronation may be a sign of another issue in another region of the body. Restricted ankle joint ROM, poor core strength and control, which may be the real issue we should be looking at, rather than focusing on the pronating foot. The other thought is we can retrain our gait to not only treat the issue of excessive pronation but also look at make the other issues mentioned a thing of the past.

 

References:

  1. Impact of Foot Type on Cost of Lower Extremity Injury
Deydre S. Teyhen, Lindsay A. Nelson, Shane L. Koppenhaver, Laura K. Honan, Alli E. McKay, Andrea R. Young, Douglas S. Christie
  2. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study
  3. Rasmus Oestergaard Nielsen1,2, Ida Buist3, Erik Thorlund Parner4, Ellen Aagaard Nohr5, Henrik Sørensen1, Martin Lind6, Sten Rasmussen2



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