Almost everywhere you turn you can see someone with worn shoe heels! And they seem quite unconcerned . . . oblivious to the fact that they have a problem. In fact, when such a situation is pointed out to clients during an assessment, they blame the shoes if they had noticed; many aren’t even aware, and respond in shock to the revelation along with the reasons for it. When shoes wear on the outside it’s called supination, while the opposite is known as pronation. This article will focus on supination, that is, where the foot turns inward at the ankle with the person tending to walk on the outer border of the foot.
With supination the outer ankle bone appears more prominent than the inner ankle bone. Given supination is a twisting of the foot, all tendons and muscles which run from the leg and ankle into the foot will be twisted. As well, when the foot rolls outward, it places most of the weight onto the outside of the foot and raises the arch. Supination is a normal part of the gait cycle (walking/running), which allows the foot to form a rigid structure for force. Excessive supination is referred to as over-supination.
Over-supination tends to be rarer than over-pronation (its opposite), and causes problems especially for runners and other athletes; since in this position, the foot is less able to provide shock absorption. It therefore predisposes the athlete to:
• Shin splints
• Plantar fasciitis
• Ankle sprains
• Stress fractures.
Due to the excessive tightness of the soft tissues of the foot, the bones of the feet shift. When this happens, the muscles which attach to these bones must also shift, or twist, in order to reach the bones they attach to. The strongest and most important muscles which attach to our foot bones come from our lower leg.
The muscles referenced course down the leg and across the ankle; they must twist to maintain their proper attachments in the foot. The twisting causes shin splints, tendonitis, fatigue, muscle aches, pains, cramps, and loss of muscular efficiency which means reduced ability to walk and run.
If not treated, it also leads to heel spurs, plantar fasciitis, metatarsalgia (ball of the foot pain), thick/painful calluses, bunions, hammertoes, high arches that are painful when not properly supported; as it progresses – knee, hip, and lower back pains.
There are two major causes:
1) The heredity factor is the most common factor; it is possible for you to inherit this biomechanical defect.
2) The way our feet were positioned in the uterus while we were developing; this is called a congenital defect.
Signs of over-supination
1) Extremely high arches
2) Significant wear and tear on the outer sole of shoes, tends to be most evident in walking/running sneakers
3) Having foot imprint testing/consultation done would show the heel and forefoot are barely connected, and in some instances, not connected at all.
In Children – once diagnosed before the child reaches five, the bones and joints can be aligned properly as growth continues. This allows the muscles of the leg to enter the foot without twisting. With proper and early treatment, the foot may not turn in at the ankle, and the child’s gait would improve.
Treatment options usually are night braces, orthotics (arch supports), and exercises. These treatments usually continue until growth is complete, and then the adult may need to wear orthotics to prevent the supination from returning. Like with other body part, if not properly treated, the condition can return. Prompt attention is critical. Waiting for a child to “outgrow” the problem could be risky.
In Adults – the most effective non-surgical treatment for supination is orthotics.
How orthotics for supination work:
• Orthotics gently redistribute the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist in at the ankle, but will strike the ground normally when the orthotics are used. The orthotics will help to prevent the various symptoms from coming on.
• The bones and joints that form the arch are supported by the orthotics. Generic orthotics generally would not provide the required level of support. Each high arched and supinated foot is different, and the height of the arch varies from individual to individual. The only way to provide the support that you may need is with a custom-made orthotic.
• Orthotics maintain a normal alignment of the bones and joints of the foot. If the bones and joints are aligned properly, by reducing the supination, the muscles can run straight to their attachments in the foot, without twisting to get to these bones. This action will also allow the leg muscles to work more efficiently, thus allowing you to walk and run with less effort.
• With every step we take, we place at least half of our body weight on each foot. As we walk faster, or run, we can exert more than twice our body weight on each foot. With this amount of weight applied to each foot, there is a significant shock passed on to our body. Orthotics absorbs some of the shock in a bid to protect the areas usually affected.
Your feet mirror your general health . . . cherish them!