by Mark N. Charrette, DC
Excessive foot pronation is one of the most common conditions affecting the human frame. This is a condition where the foot rolls inward, creating a foot that is flatter, wider, and longer. A subluxation pattern of the various tarsals and metatarsals results.
As Chiropractors, we understand that the foundation of the spine is the pelvis, and any pelvic misalignment can affect the biomechanics of the lumbar, thoracic, and cervical sections of the spine. What we must remember is that the pelvis is itself dependent upon the status of balance in the lower extremities and the pedal foundation.
Effects of Imbalance
Any structural imbalance—such as an anatomical leg length inequality, pes planus, etc.—requires compensating movements in the lower extremities and pelvis in order to minimize as much as possible stresses and strains that would affect the spinal column. Over time, however, specific muscle imbalances and shortenings will develop. Eventually, both the soft tissues and bones are damaged by microtrauma, which can eventually lead to pain and discomfort.1 2 3 4 5
A functional imbalance, such as collapse of the arches of the foot, also results in excessive motion during the various phases of gait. With excessive pronation, the leg spends too much time in internal rotation, placing twisting stresses on the pelvis with each step. In time, this results in overstretching of the hip and pelvic support ligaments and may also cause chronic pain and dysfunction.
Evaluation for Imbalance
An evaluation to check for lower extremity imbalance should be performed on every patient who presents with chronic musculoskeletal conditions of the spine or lower extremities. This can be done with a quick and easy screening procedure, such as a weightbearing examination. The following is a recommended series of observations to make while the patient is barefoot and standing:
Foot flare. Toeing out while walking indicates hyperpronation. Weight falls on the medial longitudinal arch, leading to plastic deformation that weakens the foot’s supportive qualities.
Knee rotation. Hyperpronation forces the patella to rotate medially, indicating excessive leg movement. The tibia and femur rotate medially, increasing the risk of abnormal hip rotation.
Bowed Achilles tendon(s). The Achilles tendon bows in on the side of hyperpronation. The calcaneus tilts inward, bringing the talus with it. Stress may extend to the tibia and along the entire Kinetic Chain.
Low medial longitudinal arches. With the patient in a normal, relaxed stance, insert two fingers beneath each medial longitudinal arch. Tight plantar fasciae, with possible pain or pressure, indicate foot imbalance. As the patient shifts weight outward, note tissue relaxation and absence of pain.
Shoe wear. With hyperpronation, excessive heel wear on the outer edges occurs. Check also for lateral distortion in the counter and/or shoe vamp.6
The 20 to 30 seconds required to perform the above exam is time well spent in avoiding treatment frustration and improving patient outcome. The information that you gather about the feet will be very helpful in dealing with postural distortions and pain farther up the body. For example, positive findings often indicate a need for individually designed stabilizing orthotics to help stabilize the spine and pelvis and absorb heel-strike shock.
Typical Subluxation Pattern of the Pronated Foot
When the foot pronates, creating a longer, wider, and flatter foot, the tarsal bones subluxate in a predictable pattern. The first, second, and third cuneiforms will subluxate in an inferior direction.
Adjustment for Inferior Cuneiforms 1-2-3
The doctor stands on the involved foot side, facing the opposite foot. The superior, or headward, hand makes a U-shaped contact over the talus-navicular-cuboid area on the dorsal surface of the foot. The doctor applies inferior traction with this hand while keeping the forearm as parallel as possible to the tibia.
The medial-anterior border of the doctor’s inferior or thrusting hand contacts the plantar surface of the foot. A dynamic thrust is given in a superior line of drive while the superior/headward hand applies inferior traction.
Rotating the foot slightly internally or externally can bring about relaxation, making this adjustment more effective.
About the Author
Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. He has lectured extensively on spinal and extremity adjusting throughout the United States, Europe, the Far East, and Australia.
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