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Pronation
 Pronation is a turning outward of the foot at the ankle, so that one has a tendency to walk on the inner border of the foot. When a foot and ankle pronates to a great degree, we call it over-pronation. You can test for pronation by looking at the leg and foot from the back. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon will run straight down the leg, but when it lies on the heel it will twist outward. This makes the inner ankle bone much more prominent than the outer ankle bone. Because pronation is a twisting of the foot, all of the muscles and tendons which run from the leg and ankle into the foot will be twisted. If left untreated, pronation may be the cause of heel spurs, plantar fasciitis, frequent ankle sprains, shin splints, weak and painful arches, and eventually knee, hip, and lower back pain.
Causes of Pronation:
The most common cause of pronation is heredity — we inherit this biomechanical defect. The second most common cause is due to the way our feet were positioned in the uterus while we were developing; this is called a congenital defect. In either instance, the following occurs in our feet during our development:
The muscles, ligaments, and other soft tissue structures which hold our bones together at the joints become looser than normal. When the bones are not held tightly in place, the joints are not aligned properly, and the foot gradually turns outward at the ankle, causing the inner ankle bone to appear more prominent. The foot moves in this direction because it is the path of least resistance. It is more difficult for the foot to move in the opposite direction (this is called supination). As we develop, the muscles and ligaments accommodate to this abnormal alignment. By the time growth is complete, the pronated foot is: abnormally flexible, flat, and its outer border appears raised so that as you step down you do not come down equally across the entire foot; instead, you come down mostly on the inner border of the foot. Normal aging will produce further laxity of our muscles which causes the pronation to become gradually worse.
Results of Pronation:
Due to the laxity of the soft tissue structures of the foot, and the fact that the joints are not held together properly, the bones of the feet shift. When this occurs, the muscles which attach to these bones must also shift, or twist, in order to attach to these bones. The strongest and most important muscles which attach to our foot bones come from our lower leg. So, as these muscles course down the leg and across the ankle, they must twist to maintain their proper attachments in the foot. This twisting of these muscles will cause: shin splints, Achilles Tendonitis, generalized tendonitis, fatigue, muscle aches and pains, cramps, ankle sprains, and loss of muscular efficiency (reducing walking and running speed and endurance). The problems we see in the feet, which are due to pronation include: bunions, heel spurs, plantar fasciitis, fallen and painful arches, hammer toes, and calluses.
Treatment of Pronation:
Custom-made orthotics will reduce the twisting of the leg muscles as they enter the foot, by maintaining a normal alignment of the bones and joints of the foot. If the bones and joints are aligned properly, by reducing the pronation, the muscles can run straight to their attachments in the foot, without twisting to get to these bones. This action of custom-made orthotics will reduce Achilles Tendonitis; shin splints; ankle, knee, hip, and lower back pain; and leg cramps. This action will also allow the leg muscles to work more efficiently, thus allowing you to walk and run with less effort.
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