Will Over-Pronation Need To Have Surgical Treatments

Overview


The foot and ankle complex needs to pronate to make the muscles of the hips and legs work correctly. Many muscles that originate from the pelvis attach to both the upper and lower leg. For example, the gluteus maximus and tensor fascia latae (TFL) attach to the outside of the lower leg via the iliotibial band, while the abductors attach to the outside of the femur. When the foot pronates, the whole leg rotates inward toward the center line of the body. This inward rotation pulls the attachment of the glutes, TFL and abductors away from the origin of these muscles up on the pelvis which creates tension. Similarly, the muscles of the lower leg such as the peroneals, tibialis anterior and tibialis posterior originate on the lower leg and attach to the underside of the foot. When the foot flattens out, as it does in pronation, this pulls the insertion of these muscles away from their origin on the tibia. This action also creates tension in the muscles.Pronation


Causes


Pronation can occur as an overuse syndrome in active runners, where a great deal of stress is placed on ligaments and tendons that support the medial column. Obesity is another predictor for pronation and deterioration of the medial ligaments and posterior tibial tendon due to excessive stress on these tissues. Acute Trauma can also lead to over-pronation when ligaments are torn or tendon is ruptured. Once again this can lead to a collapse of the medial column. Arthritic conditions involving the knee joint when the joint is in varus (inner collapse) posture, this places the center of gravity over the ankle joint rather than the foot causing undue pressure on the inner ankle.


Symptoms


In addition to problems overpronation causes in the feet, it can also create issues in the calf muscles and lower legs. The calf muscles, which attach to the heel via the Achilles tendon, can become twisted and irritated as a result of the heel rolling excessively toward the midline of the body. Over time this can lead to inflexibility of the calf muscles and the Achilles tendon, which will likely lead to another common problem in the foot and ankle complex, the inability to dorsiflex. As such, overpronation is intrinsically linked to the inability to dorsiflex.


Diagnosis


One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).Over-Pronation


Non Surgical Treatment


Personal orthotics can be prescribed via your healthcare professional. If finances or insurance are issues, similar and often better options can be purchased online for overpronation. The right walking shoes are also essential. Most shoes cater to neutral foot gaits, unless they specifically state otherwise. That won?t help you if your foot rolls inward. In order to correct the issue, you need shoes with stability or motion control abilities, low heels, deep heel cups, and good arch support.


Surgical Treatment


Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.


An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.

tag : Overpronation Of The Foot

Comments

Post a comment

Only the blog author may view the comment.

Trackbacks


Use trackback on this entry.

Search form
Display RSS link.
Link
Friend request form

Want to be friends with this user.