"Stop Slouching!": Pronation

I never used to pay attention to articles about pronation. Why? Because I didn't think I overpronate (but those are my feet up there). In fact, I tend to walk on the blades of my feet. Which made me think that I supinate. But there's more to pronation than just the way your ankles tilt, or whether your toes turn in or out (mine turn in). Additionally, I have some clients who are guilty of absolutely criminal pronation. So I've had to do a lot of research to figure out pronation, why it's bad, and what (if anything) we can do to correct it. I'm pretty excited about writing this article, and I hope it's helpful.

Diagnosis
You probably recognize pronation, even if you don't realize it. Pronation, which is also sometimes called being flat-footed (although they're two separate phenomena, if you ask me), refers to the inward, medial rotation of the foot at the ankle. The main symptom is an arch that collapses as you put weight on your foot. Here's a video to watch (and I'm sorry if you don't like feet).



Note how the arch collapses and the ankle rolls in. Gross, yeah? To see if you overpronate, check to see if the arch is collapsed (or possibly non-existent), if the inside edge of your foot bulges when you're standing relaxed, or if your ankles noticeably roll in as you put weight on them.

Neutral Foot Position

Pronation/overpronation and supination/underpronation are both caused by an ankle that cannot retain neutral position. So in order to correct any functional over- or underpronation, you have to learn how your foot is supposed to sit, and how that's supposed to feel. I've found two practical ways to do this--one with a trainer or coach (or partner or training buddy), the other alone.

Here's the first, taken from a great article by Justin Price on ptonthenet about overpronation:

There are two small indentations at the base of the ankle just below the ankle joint. Place your thumb on the dimple on the inside of the ankle and your forefinger on the dimple on the outside (see Figure 4). Ask your client to roll her foot and ankle inward (overpronate). You will feel pressure on your thumb. Ask her to roll outward (oversupinate), and you will feel pressure on your forefinger. This pressure is the talus bone moving in the ankle. Coach your client to pronate and supinate until you feel even pressure of the talus bone on both your thumb and forefinger. This is the anatomical neutral position for the foot and ankle. Most people will have to supinate to get to neutral from their dysfunctional overpronated position.

This method is useful because it's more absolute, more technical. So if you're the typical Type A triathlete, this is the method for you, although you'll need another person's assistance to work it out.

The second method is much more intuitive, and I've derived it from yoga. Stand in Tadasana (Mountain Pose). Make sure your weight is evenly distributed through the three main points of contact between your feet and the floor (heel, joint of the big toe, joint of the little toe, i.e. first and fifth metatarsal). Once you're in a proper Mountain Pose (and if you don't know how to do this, shame on you! go to yoga!), lift your toes. You should feel your arches lift. Now lower your toes, but don't let your arches fall. If you're like me, you'll feel the muscles in your lower legs--really, like all of them--engage, and just standing like that will be exhausting. At this point, you should feel like the muscles underneath the plantar fascia on your feet are engaged, the weight is evenly distributed betwen the three points of the foot, and you have three natural arches (forming a triangle on each of your feet).

How to Fix it
You might notice that I strongly advocate the practice of yoga for strengthening the arches. It's a great place to start.

But what if you lack the time and money to attend yet another class every week (preferably multiple times a week)? After all, not everyone works at a gym!

Try these simple exercises to strengthen your foot muscles, relax your flantar fascia, and become a better person.

Golf Ball Roll

Exactly what it sounds like. You've used a foam roller before? Same idea here. You're using the golf ball to perform self myofascial release (your own personal deep-tissue massage!) on the plantar fascia in your foot. Roll the golf ball under each foot for 30-60 seconds, stopping on any painful places. As you do this, perform an active stretch of the muscles underneath the fascia by pulling your toes up towards your shins.

Big Toe Pushdowns

Stand with your foot in neutral position (see above). Push down through your big toe without allowing the ankle to roll in or the arch to collapse. Start by holding that for 5 seconds, 10 times on each side (or do both sides at once). As you get stronger, hold the toe down for longer stretches and fewer repetitions. You'll start to feel that muscle (flexor hallicus) contract under the arch of the foot. As it gets stronger, you'll be able to consciously engage that muscle whenever you're doing a weight bearing exercise.

Calf Stretch w/ Tibialis Anterior Activation

You've probably done this stretch plenty before, but this time you're going to do it with a neutral foot position, while pulling your toes up. One foot forward, one foot back. Press the heel of the back foot into the floor behind you. But don't let your ankle roll in, mkay? That kind of defeats the point. Pull the toes of the back foot up toward your shin. And hold. Feels nice, right? The other trainers and I always joke about how we love being stretched out. Until someone tries to stretch our calves. At which point we want to kill somebody. Hold for 30 seconds on each side, repeat 3-5 times.

Pronation and Yoga
Yoga is always practiced barefoot. The book I've been reading recently (Yoga Anatomy) connects the three natural arches of the foot to the muscle lock Uddiyanabandha, in which you pull your deep abdominals in and up. So I recommend doing some yoga practice to help your feet. Not only is it a great option for increasing flexibility and preventing injury, it's going to improve your biomechanics. And I speak absolutely 100% from experience. Do it; it helps; and it's a lot more fun to take a yoga class than to add a 1-hour stretching workout to your weekly routine (on top of swimming, biking, running, nutrition, weights . . .)

In addition, practice a mild Uddiyanabandha when you're running, walking, going up stairs, even when you're cycling. If nothing else, making the connection between arch and abs forces you to bring your mind back to what your feet are doing. And you can't go wrong with being more mindful in your running and cycling.


Why it Matters

Ankles, hips, and knees are all intimately related. If one of those joints is out of line, the others are going to suffer. That means that when you overpronate (or underpronate, for that matter), your hips and knees are going to feel the effects as well.

Pronation can also affect your performance in the bike, although the effects tend to take longer to appear. I attribute my achilles tendinitis to the excessive overpronation of my right foot. With each pedal stroke--every time I put weight on my right foot--the arch rolls in, which takes my ankle out of alignment, putting excessive strain on my achilles tendon. Note that this problem can also be caused by having bike shoes that don't fit properly, or by excessive amounts of rock in your shoe/cleat/pedal fit (especially with Speedplay).


Also? Plantar fasciitis. Bunions. Shin splints. IT band pain. Are those not enough reasons for you to do something about this problem?


Conclusion
A couple weeks ago at my local run shop, I asked the proprietor if there are exercises you can do to correct overpronation. He said no; in his mind, the only option is motion-control shoes and, if those don't work, orthotics. Based on the research I've done, I strongly disagree, with one caveat. In my mind, there are two kinds of pronation: structural (i.e. bones, tendons, ligaments) and functional (i.e. muscles and laziness). Some people are born with flat feet, and they will always need corrective aids to avoid overpronation. Most of us, however, are overpronators by circumstance. Our feet have evolved to move us (barefoot) over uneven ground. Instead, we stick our feet in shoes and push them around pavement. No wonder they don't know what the hell they're doing.

My biggest recommendation to you overpronators (and, consequently, to myself) is to get outside and play barefoot. Teach those muscles under your plantar fascia how to function again! Do some barefoot trail running. Run around the lawn barefoot with your kids. Heck, maybe even try a barefoot marathon. The yoga is great and will work wonders, but using your feet the way they were meant to be used is even better.

Or don't. Keep wearing your big, ridiculous, motion-control shoes. The rest of us are going to laugh at you, though, as we run by wearing our light, sexy, don't-need-no-support racing flats.


Note: big props to my sources on this article.

Kaminoff, Leslie. Yoga Anatomy. Champaign, IL: Human Kinetics, 2007.

Price, Justin. "Corrective Exercise - Part 1: The Foot, Ankle and Knee." PTonthenet, 19 May 2008. http://www.ptonthenet.com/displayarticle.aspx?ArticleID=3043
Yeah, it's MLA style. So what? What else would you expect from an English major?