From the Guidelines
Pronation of the right foot should be addressed with supportive footwear and custom orthotic inserts to correct the alignment and prevent potential complications such as plantar fasciitis, shin splints, and knee pain. To manage this condition, it is essential to use orthotics and braces that can reinforce, unload, and protect tendons during activity, as they are valuable adjuncts to therapy and can help correct biomechanical problems, such as excessive foot pronation 1.
Key Recommendations
- Use supportive footwear with good arch support
- Consider custom orthotic inserts to help correct the alignment
- Physical therapy focusing on strengthening the muscles that support the arch, particularly the tibialis posterior and intrinsic foot muscles
- Exercises should include foot intrinsic strengthening (toe curls, towel scrunches), calf raises, and balance training on unstable surfaces, starting with 3 sets of 10-15 repetitions daily
- Proper stretching of the calf muscles and Achilles tendon can help improve foot mechanics
In terms of prevention and management, it is crucial to identify high-risk foot conditions, such as altered biomechanics, and take measures to prevent complications, including the use of footwear that cushions and redistributes pressure 2. However, the primary focus should be on addressing the pronation issue directly, and the evidence from 1 provides the most relevant guidance on this topic.
From the Research
Patient's Right Foot Pronates
- The patient's condition is characterized by the inward tilting of the ankles and flattening of the arches, which is a normal part of walking and running, but can be excessive and lead to foot, ankle, or knee pain 3.
- Pronation of the foot is one of the commonest reasons for prescribing orthotics for the lower extremity, and many different bracing systems are available for the management of this complex problem 4.
- The use of orthotic therapy as a modifier of the natural history in simple pronation remains controversial, and the selection of cases for treatment depends on the type, as pronatory deformities can be grouped according to markers that are cause specific 4.
Treatment Options
- Properly designed shoe inserts, called orthoses, can help correct overpronation 3.
- Antipronation tape and temporary orthotics can help to control excessive foot pronation initially after application and following exercise 5.
- The effects of these treatments remain largely untested, but they may be useful in the assessment and treatment of lower limb injuries that are associated with abnormal foot pronation 5.
Factors to Consider
- The medical condition resulting in pronation and necessitating bracing may alter after the selection of the orthoses 4.
- Patient factors, such as the type and severity of pronation, guide the physical therapist in deciding which assistive devices to try for which patients 6.
- A simple decision tree can help guide the selection of treatment options 6.