CAN YOU FIX FLAT FEET AND OVER PRONATION?
Can you fix flat or over pronating feet? This is a question I often get asked by clients, and my answer has changed over the years of my PT career as my knowledge and understanding has developed. I have consulted countless physios, osteos, and podiatrists to help me and the state of my feet (and subsequently the rest of my body) and it's fair to say that there is a lot of debate as to whether over pronation and flat feet can be fixed or even if they need to be fixed. In this blog I share what I have come to learn and understand about my own feet, explain what over pronation is, the difference between that and having flat feet, and discuss whether orthotics help or hinder. Read on to learn all about feet and whether, in my opinion, you can correct over pronated or flat feet.
FEET FEET FEET FEET. I am currently obsessed with feet at the moment as most of my clients will well know. I am fascinated by biomechanics and how the body moves and responds to what happens from the ground up. I personally have had foot issues since I was a child with incredibly flat feet, so flat that if I jumped without concentrating on my landing, the lack of pronation and therefore reduced capacity for shock absorption, would send a huge shock wave of pain through my feet and up my legs. Excruciating and not much fun for an active child. In saying that, it happened just the other day when I landed too heavily coming off a climbing rope. Ouch!
My foot issues have been at the root of many of my injuries and joint dysfunctions over the years, or at least if they haven’t been at the root of the problem, they haven’t helped. I’ve suffered chronic lower back, hip, and knee pain, meniscus tears in both of my knees, and one might even attribute any shoulder pain to the dysfunction occurring from lower down the chain in my feet. I have had treatment from plenty of physios and osteopaths in my time and wear expensive orthotics prescribed by a podiatrist. But do orthotic insoles help or hinder? There’s quite a lot of debate about their long-term use and there’s also debate about whether flat feet can be ‘fixed’ at all. So, let me share with you my experience and what I’ve learnt as a personal trainer about feet and their function.
What is pronation and supination?
Pronation and supination are completely natural actions that the foot should have. Foot pronation is a combination of eversion of the mid foot, abduction of the forefoot, and dorsiflexion of the ankle, or more simply put, is when the foot rolls inwards, arch collapses, and foot lengthens. This ability to pronate and splay the foot out allows our feet to adapt to the ground surface and absorb shock by distributing the impact.
Supination of the foot is the reverse; inverting of the mid foot, adducting the forefoot, and plantar flexing the ankle i.e. the foot shortens and rolls onto the outer edge of the foot. The action of supination packs the foot into a tighter structure that gives us rigidity in order to generate propulsion and push off the ground.
During the gait of walking the foot swiftly moves from supination to pronation when the heel strikes the ground, flattening the foot to reduce shock and begin to stabilise the foot. As our weight travels over the foot it begins to supinate again to form a rigid structure and supportive arch that allows us to push off the ground before we swing through and repeat the process.
As you can see it is a very complicated process where the timing of each action is crucial, and an excessive or inadequate pronation or supination, or a delay in the transitions from one to the other, can alter the gait cycle and affect the rest of the limb and body further up the chain.
In this blog I will be discussing over-pronation as in all my years as a PT I’ve come across more clients with excessively pronated and flat feet than feet that are over-supinated.
What can cause over-pronation?
Too much pronation can be the result of overactive muscles in the calves such as the gastrocnemius, soleus, and the Achilles tendon. As these muscles tighten and shorten it restricts ankle mobility which then forces the body to overcompensate by creating more movement in the foot instead, by way of excessively pronating. Muscles in the outer side of the lower leg that everts the foot, a group of muscles called peroneals or fibularis, now become over active, and in turn causes the supinating muscles, such as the tibialis posterior, to become under active and weak.
Having flat feet or fallen arches will also cause over-pronation. Having flat feet and feet that over-pronate are 2 different yet related things. If you have flat feet you will most definitely be an over-pronator as your feet naturally stand in a splayed-out pronated position. However, one can over-pronate during weight loading movement such as while walking or performing a squat, but have a neutral foot with adequate arch height when standing still.
The latter are the fortunate ones that with the right corrective exercises to increase ankle mobility by releasing the overactive calves and peroneals, and retrain and strengthen the foot supinators, can return to a normal amount of pronation more easily.
What causes flat foot?
Flat foot has many causes and can often be a hereditary condition. Some conditions can be nerve or bone related such as with neuromuscular disorders or abnormal bone growth and joint fusion. Others like myself have hypermobile joints and extremely flexible ligaments that no matter how much you strengthen the muscles in and around the feet, will always have super floppy flexible feet unable to build enough strength to create a supportive arch. (Yes floppy foot is a technical term). And very commonly there are flat feet that are simply caused inappropriate footwear with narrow toe boxes, and by over tight calf muscles and tendons as mentioned above. So one could originally have had a normal arch height and developed flat feet as calves tighten over time and foot function deteriorates.
Do orthotics help?
The use of orthotics is a tricky one as treatment of foot dysfunction is dependent on the severity and cause of over-pronation or flat foot, and while having orthotics to help support fallen arches and reduce pronation can be a necessary thing, it can also be a crux. Wearing orthotics is equivalent to having your foot in a cast. It helps hold your foot in place to stop any excessive movement, but in doing so it doesn’t allow the muscles within the foot to activate and react as it should to the environment with every step that it takes. Not allowing muscles to fire as they should in response to stimuli further reduces foot function.
However, this is not to say that orthotics shouldn’t be used at all. People who suffer with pain can find great relief with orthotics and can benefit from short term use of them while they work to address the causes of over-pronation or flat foot. If the cause is a functional issue i.e. some muscles have become too tight and others have weakened, then over-pronation may be corrected by:
releasing and stretching the overactive calf muscles and peroneal muscles
activating and strengthening the weak ankle and foot arch muscles
activating and strengthening the weak hip and knee stability muscles further up the chain
re-teaching the foot and your toes to react and alter your gait accordingly
addressing the cause of tight calf muscles such as wearing heeled shoes that shorten the calf muscles, or walking with your feet turned out
It’s a long process but that’s the theory anyway to correcting over-pronation and ‘fixing’ flat feet if the cause is a functional one. In cases such as mine, it is not that simple. My lax joints make it hard for me to strengthen the arches enough to support my weight no matter how many exercises I do. Historically, going too long without support in my shoes caused hip, knee, and back pain, and so I have had constant use of my orthotics for the last 7 years. And in doing so my feet have become even more lazy and unresponsive.
With the years of experience and teachings from various biomechanical geniuses we have concluded that my floppy flat feet are here to stay and that’s ok. Though I believe that my flat feet cannot be ‘fixed’, I can still work to improve my foot function. I am re-teaching my feet to react by being barefoot as much as possible and wearing barefoot shoes/trainers that have thin soles and wide toe boxes. And I am conscious of how my feet move when walking, especially in the push off phase of the gait cycle when my feet need to supinate and drive with force off the big toe joint. And strengthening my glutes and hip stability. It takes a lot of effort but I’ve seen improvement in the last few months and have seen a huge reduction in the daily pain I used to get in my hips and knees, and actually feel like I am closer to being biomechanically sound, to the point where I am no longer wearing orthotics and am still (so far) pain free!
Over pronation and flat feet are commonly grouped together as the same condition but as you can see it’s just not that simple. A common question that is asked is whether you can fix flat feet/over pronation? My answer to that is well … it really kind of depends! On whether it’s a structural or functional issue, and whether it even needs to be fixed at all? From my own experience I haven’t changed the arch height in my foot whatsoever, but by strengthening my feet and toes, and hip stability, and improving my gait from how my feet move to how my hips sway when I walk, I have never been as pain free as I am today and can train without risk of injury!
If you’re in a similar situation my biggest recommendation is to seek a good physio who specialises in gait correction, stretch and massage your calf muscles, stop wearing highly cushioned, heeled shoes, with narrow toe boxes, and spend as much time barefoot as you can to retrain your feet to move as they were designed to.