Of all potential foot orientation & postural deficits, overly collapsed arches and pronated feet are probably the most common.
But it may not even be a problem. Lots of people have what some would consider “excessive pronation”, but never have pain related to that orientation. It can cause problems if left unchecked, especially if it is a result of (or causing) compensatory positioning up the chain, potentially all the way to the neck.
I will address the following:
- How pronation can develop
- Implications of pronated feet
- What we can do about it
TL;DR: If your feet are flat, you are not going to get your arch to “re-rise” without a lot of help, especially from something like an orthodic. Pay attention to your pelvis because it’s a primary factor.
What is happening with pronation?
LaFortune et. al, 1994 found that the most common scenario was that the tibia was forced to internally rotate due to the valgus stress created by the pronated foot.
Interestingly enough, the femur rotated to the exact same degree so that no net rotation occurred between the femur and tibia.
Instead, all the motion induced at the foot traveled through the knee and was absorbed by the hip.
𝐓𝐡𝐢𝐬 𝐜𝐨𝐮𝐥𝐝 𝐦𝐞𝐚𝐧 𝐭𝐡𝐚𝐭 𝐞𝐱𝐜𝐞𝐬𝐬𝐢𝐯𝐞 𝐩𝐫𝐨𝐧𝐚𝐭𝐢𝐨𝐧 𝐢𝐬 𝐦𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐬𝐭𝐫𝐞𝐬𝐬 𝐭𝐡𝐞 𝐡𝐢𝐩 𝐭𝐡𝐚𝐧 𝐭𝐡𝐞 𝐤𝐧𝐞𝐞.
But how does this happen?
Potential Scenario #1
If the pelvic innominate bone is forward/anteriorly tilted on the side of the pronated foot, the femur (thigh bone) externally rotates and turns outward. The tibia (lower leg bone) can follow it into external rotation and then in order to not have everything go “outward”, we walk on the inside of our feet for stability.
Potential Scenario #2
Another option is that the pelvic position can cause the femur to compensate into internal rotation. The tibia and knee follow it in. This is similar to what was described above in the LaFortune study.
This causes the foot to pronate.
This is why it’s important to consider implications from both the foot and the pelvis. You cannot separate the two.
Implications of an excessively pronated foot
A pronated foot that cannot go into supination effectively can stress the foot ligaments and also the plantar fascia (Bolga & Malone, 2004).
It can also cause the foot to try and find stability via causing the talus to move outward, stressing the subtalar joint.
This can result in a faulty gait pattern (ideal versus faulty due to pronation), which can cause bunions on the foot to build up (Golightly et. al, 2014).
What do we do?
In all likelihood, your arch is not going to permanently rise again. The intrinsic foot muscles are just not even potentially strong enough to reorient the foot permenently underneath the load of your bodyweight. But that doesn’t mean it’s a lost cause.
We need to be able to sense an arch and keep one to a certain extent when we need that, and we can do that through orthodics (which is too individual to address here), but there are also a few tools at our disposal that are easy:
- Make a Paper Towel foot arch – This is a very effective tool to be able to sense your arch and help your brain “sense the floor” better.
- Utilize Janda Short Foot Technique when doing stationary exercises like a squat or lunge. This will help provide stability throughout the foot and leverge the arch to do so.
- Footwear solutions – To find a shoe that best helps in this sitation. look for the following qualities . It’s hard to give blanket recommendations because footwear tends to be very individual, but these shoe qualities should be present.
But it’s important to also recognize that these are mostly surface-level solutions. If your pelvis is still out of position and contributing to the issue, then these will only help so much. An optimal approach involves using these tools alongside a corrective exercise program to help restore a better orientation throughout the lower body.