During the last few posts I have been discussing what pronation is, and how to control it using supportive shoes and targeted exercises.  But up until now I have ignored the elephant in the room. Orthotics.

There are a few reasons I have left this topic for last; mostly because it is complex but also because it’s controversial. People who make orthotics, like Podiatrists or Pedorthists, tend to say that anyone who pronates (and that is pretty much everyone) needs some form of arch support or orthotic.  I think this approach might be a bit excessive.  Rehabilitation experts, exercise specialists and Physical Therapists usually tend to claim that all pronation problems can be resolved with strengthening and stretching.  I think this perspective is an unnecessarily slow solution to the problem of pronation. As with most subjects, the real solution probably lies somewhere between the two extremes. I think the following principles are important to keep in mind any time you are thinking about using orthotics to correct pronation:

Not everybody needs orthotics.

You have heard the expression “if it ain’t broke, don’t fix it”…well, I would like to apply that same sentiment (with a few minor tweaks) to the idea of using orthotics. My new adage would be “if it hasn’t caused a problem yet, and you don’t think it is likely to…just leave it alone.” I know this saying is not as catchy as the old one…but oh well – it was the best I could come up with on short notice.

To illustrate this point, I would like you to consider a picture of a crooked house:

Imagine what would happen if you decided that you wanted to straighten out the entryway on this building. A new, square, prefabricated door would never fit correctly. You would have to tear out and replace all the old hardware and the door frame and probably quite a bit of the wall.  Even if you did make it work, it would look funny and the chances are that you would have created a whole variety of other problems that you didn’t want to deal with. Hippocrates understood this concept, which is why the first part of the oath that is (or should be) drilled into every medical professional’s mind reads “First, do no harm”.  Some houses are just meant to be crooked; some people just weren’t intended to have textbook biomechanics. The word Orthotic comes from the Greek root Ortho- which means “to straighten or to correct”.  But not everyone really needs correction; some people do just fine without it.  How can you tell the difference? Trial, error and good judgment – which is why it is important get advice you can trust.

But some people sure do!

Take a look at this house:

This is a place that needs some serious help. The gaping hole in the foundation has impacted the entire structure. This building is clearly having trouble because of its crookedness. Instead of adapting to a new angle like the place in the top picture, this house is crumbling apart. Sometimes pronation is a big deal and peoples’ bodies are unable to handle the crookedness. These people may experience severe injury and chronic symptoms because of the collapse of their support system if they are not given some correction before it is too late.

Pronators need orthotics if:

–          They have classic pronation symptoms

  • Medial knee pain
  • Low back and hip pain
  • Ankle pain
  • Bunions/ painful toes

Or:

–          They put their feet through excessive stress, creating a high injury risk

  • High body weight (not just obese people, but anyone who is tall or muscular too)
  • Lots of high impact activity (athletes, hikers, people who are on their feet all day)
  • Long periods of static standing (Standing still is harder on your body than walking, especially on a hard surface)

Orthotics are just one part of the solution

I want to switch analogies here from crooked houses to a laundry stain

If you have a minor stain on your shirt, you will most likely try to get it out with soap and water. If that doesn’t work, your next move will probably be using extra strong laundry detergent when you put it in the washing machine, and if you really can’t get the stain out you might have to use a stronger chemical such as bleach.

Pronation control is a bit like this; if the problem is minor, you can probably solve it with just some good quality, supportive shoes. If the pronation issue persists, you may have to add some exercises into the mix. If you can’t control your pronation with these two options then you have to pull out the big guns and use orthotics. But keep this in mind: Orthotics can’t do it all! If you need orthotics then you also need good shoes and you should be doing some basic exercises as well.

In my next blog I will be giving you an overview of the different types of orthotics that can be used to control pronation. Until then, walk well!

Pictures from:

http://boldt.us/humor/the_crooked_house_banks_ales.html

http://lostinasupermarket.com/wp-content/uploads/2010/03/michbrush1.jpg

http://www.videojug.com/film/how-to-remove-grass-stains-from-clothes

Advertisements