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Supination and motion control shoes

Posted by Dara G on 2/04/04 at 14:05 (143628)

Tried asking this to my podiatrist but was not successful getting an answer, so thought I'd see if someone out here can help me.

I have higher arched, supinated feet. The right foot supinates more than the left. Judging by the reaction of my pod, I'm guessing the right foot supinates by an unusually large amount. My PF is on the right foot. I got PF in the first place from wearing Birkenstocks because they don't have enough lateral support for me, and caused my foot to supinate even more than usual, putting too much strain on the arch. I have more recently been wearing Danskos, Wolkies, and occasionally SAS with a Birkenstock air cushion insert.

What I notice from wearing the Wolkies, and to a lesser extent the Danskos, is that my right hip joint gets sore from my foot turning more inward, and I can feel changes taking place along my spine, all the way up into my neck (I do have a small amount of scoliosis). On a few occasions I have even gotten headaches from this.

When I put the SAS on I can feel my right foot relaxing outward into its more accustomed position and the changes brought about by wearing the Wolkies and Danskos feel like they start to reverse.

My left foot/hip is very little affected by changing between these different shoes.

My question is am I better off wearing shoes with some motion control in them like the Danskos and Wolkies that prop my right foot up, or am I better off wearing shoes without motion control that more so let my foot do its own thing (like the SAS)? I guess what I'm really asking is can the over supination in my right foot be corrected at all from wearing shoes with some motion control, or am I only moving the problem upward into my hip and spine by doing this?

Thank you for any help you can provide.

Re: Supination and motion control shoes

Dr. David S. Wander on 2/04/04 at 19:01 (143637)


The first thing I'd like to ask is whether your doctor has attempted to determine why one foot is supinating more than the other. Often, this may be a sign of a limb length discrepancy, meaning that one leg may be longer than the other. As a general rule, the short leg supinates to gain length, and the long leg may pronate. This may also explain some of the other symptoms you've described. Unfortunately, most methods of measuring for limb length are relatively crude, and may include measuring from your umbilicus (belly button) to your ankle on each side while you are on your back. Another method measures from your anterior superior iliac spine (pelvis) to your ankle bone. Both of these methods can be flawed, and the only real accurate method includes specialized standing pelvic x-rays or a CT 'scan0gram'.

A simple method of not having to worry about motion control characteristics of shoes, since each foot seems to have different mechanical properties, is to have orthoses fabricated to control the motion in each foot as needed. Then you will be able to move the orthoses from shoe to shoe.

Re: Supination and motion control shoes

Dara G on 2/04/04 at 23:19 (143651)

Dr. Wander,

Thank you for responding to my question.

No, my doctor has not attempted to determine why one foot is supinating more than the other. I have read about the types of things you describe, and tried to talk to my doctor about them the last time I was in, but he was unwilling to discuss them with me. I'm not sure why. He told me rigid shoes are not good for me, that I need something softer because of the supination, and gave me a pair of Apex inserts. His thought was that would help to put my foot in a more neutral position. I tried them for a while, but they didn't work very well for me. They seemed to cause my feet to supinate even more than normal. I've actually had better luck with the Danskos, even though they are more rigid, than with the Apex inserts.

I do believe I have a limb length discrepancy. I have told that to my doctor, and he said he doesn't know whether that is part of my problem or not, though it does make sense to me that it likely is. For years my right pant legs have been hemmed about 1/4 to 1/2 inch shorter than the left. A while back I had a friend help measure my legs in the manner you mention, and the measurements came out equal for the two legs.

Aside from the ability to move them from one shoe to another, would having a pair of custom orthotics made be significantly different than either shoes with softer insoles that would conform to my feet, or the Apex inserts which also conformed somewhat to my feet? Thus far the softer Apex type inserts, or shoes with softer insoles, is the direction my podiatrist has been taking me in. I just haven't found exactly the right pair of shoes, or inserts, yet to make my feet happy.

Thank you for your help. It is quite a relief to talk to a doctor who seems to have some understanding of my situation.


Re: Supination and motion control shoes

Julie on 2/05/04 at 02:44 (143656)


You mentioned in your first post that you have scoliosis. This would explain your apparent leg length discrepancy, even if your two legs seem to measure the same length. In scoliosis, the curvature of the spine results in one hip and one shoulder being higher than the other. The leg on the higher-hip side can be the same length as the other leg, but it starts higher up, producing what is known as a functional leg-length difference, rather than an actual one.

Look at yourself in the mirror. The simplest visual check of the extent to which your scoliosis is affecting your function is to observe the position of your hands. You will probably see that one hand hangs higher than the other. This isn't because the arm is shorter, it's because the shoulder is higher. The hip on that side will be higher too. The consequent imbalance in your walking (and standing) is what is causing your hip and back pain and they are almost certainly related to your PF.

I am surprised - but only a little - that your podiatrist showed no interest in this. Perhaps, as a foot specialist, he felt out of his depth when you began talking to him about your spine. But the body is a functional whole: the feet, legs, hips and lower back are a continuum and whatever is going on in one part of the continuum will affect the whole.

I agree with Dr Wander that custom orthotics made to address the motion of each foot will help, but you might also consider consulting an osteopath or chiropractor about the scoliosis, which seems to be the root of the problem. There are different kinds and degrees of scoliosis: exercises may or may not help, but it would be worth trying.

One more thing: in cases of actual leg-length difference, an elevated sole is often employed. In cases like yours, where the root of the problem is the scoliosis, that is not a good idea, so don't be tempted to go down that road.

I am not a doctor; I am a yoga teacher, and what I've said comes from my reading on the subject and my observation of students with scoliosis over the years. I hope it's helpful.

Re: Supination and motion control shoes

Dr. David S. Wander on 2/05/04 at 07:40 (143658)


If you have addressed ANY concerns with your current doctor, and the doctor does not at least attempt to give you an explanation, it is time to find another doctor willing to address ALL your concerns.

Re: Supination and motion control shoes

Richard, C.Ped on 2/05/04 at 08:49 (143669)

The custom orthotics (if made properly) will address the needs of each foot accordingly. The Apex inserts are only cushion. There is no functional purpose for them...just accomodation (if that).