Heeling it right

Many people overpronate to some degree. But if you do, what do you do about it? For many people, the answer is nothing – until it’s too late. A mild case may go completely unaddressed, or even unnoticed, for years. Often the first time it is taken seriously is when issues surface in the feet themselves, or elsewhere: the shins, knee, hip or even back.

It pays to get the problem looked at before knock-on effects emerge. But how do you recognise that you overpronate? And if you’ve already started to notice problems: a bruised feeling in your heels maybe, or your arches getting flatter, what should you do next?

What is pronation?
Pronation is a natural part of any stride, a rolling of the foot on impact with the ground that is a critical part of absorbing the shock of that impact. Normally we first touch down with the outside of our heel, before beginning an inward rolling action that sees the angle of the heel bone to the ground move through an arc of something like 15deg.

Less of a roll than this is termed underpronation, with most of the pressure from the impact absorbed by the outside of the foot; while more than 15deg or so, is termed overpronation. This often leads to the collapsing of the arch, over-extension of the calf and underfoot muscles, and a concentration of weight on the inside of the foot as you toe-off. All these things can lead to pain and injury over time.

Dr David Cosman, a Hong Kong-based chiropractor, compares it to how a flat tyre or wheel imbalance could cause the steering in a car to pull to one side. In time, this would lead to the driver having shoulder or arm strain, or even headaches.

Dealing with it
One common answer to overpronation, especially in more severe instances, is the use of foot orthotics. Orthotics are a wide family of supportive and corrective devices but people most often associate the term with the foot. Not all orthotics are created equal though – in fact many products on the shelves that people refer to as orthotics are in fact not.

Stefanie Hemshall, Managing Director of Escapade Sports in Hong Kong who work with Dr Cosman defines orthotics as: “precision-made corrective insoles tailored to individual requirements.”

Cosman’s custom-made footbeds run the length of the foot and include support for the arch, as well as correcting the excessive roll of the foot on impact. “Most people think that orthotics support the arches. Arch supports support the arches,’ he says. “Orthotics support and also correct mechanical deviations. Arch supports are fine, but It’s like comparing a Yugo to an F1 race car.”

To get fitted with orthotics, you should consult a qualified podiatrist or chiropractor who will run a gait analysis using a video camera to capture your movements.

“Proper orthotics are not easy to make – they need a proper prescription,” says Cosman. “They do not look cool or groovy when you wear them and they do not look special on the counter or shelving in a store. They are a luxury item that benefits performance if they are made according to a proper prescription that comes from a careful and thorough assessment.”

Dissenting views
Not everyone thinks that orthotics are a good idea though. Jono Rumbelo is a triathlon coach who writes a column for ironguides.net that is widely syndicated. In a recent piece on orthotics he says: “Orthotics do have a place but I personally don’t think they belong in running shoes. They are too rigid and, besides, your biomechanical function changes when you use a personalised insole of any sort.

“In order for you to stop the injury your foot needs to function. Placing a rigid device under the foot prevents that from happening so the muscular system goes to sleep and when it does start working it’s too late . . . Controlling the pronation is not so much the key but, more importantly, getting the muscular system to function efficiently.”

Cosman believes thinking like this could be flirting with disaster: “I think that those who say that are most likely leading their athletes or themselves down the wrong path. Missing on the diagnosis and the surrounding factors means . . . lots of injuries.”

Instead of orthotics, others offer simpler made-to-measure insoles in tandem with careful selection of appropriately supportive footwear.

Andrew Wright of Tribal, a triathlon shop in Hong Kong that provides custom-made insoles says: ”Our inserts are custom-molded to the customer’s foot and can be made in the shop in 20 minutes. They offer the customers support and comfort as opposed to forcing the foot into a certain position like orthotics.”

For Cosman, such an approach fails to address the underlying biomechanical condition: “There are so many factors in lower extremity function that require medical basics and advanced biomechanical knowledge with experience to boot.”

“If orthotics are indicated and not used, then lots of bad things can and do happen to the foot . . . predictable things. I am a proponent of training the body, and also a proponent of whatever is indicated and beneficial. It is a matter of being aware of the choices and not being closed-minded.”