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Orthotics - more thoughts

Posted by Julie on 11/26/04 at 03:18 (164726)

I posted this on the Treatments board and am copying it here as well.

My husband has been having trouble with his knee, and a few weeks ago our osteopath, who has been treating his back, had a good look at his feet and legs while he was standing. It was obvious to her, and to me, that he was pronating markedly on the painful knee side, and she suggested orthotics. She recommended an otc brand called Vasyli, and he decided to try them. She fitted him yesterday, and we await developments.

I read the detailed leaflet that comes with them, and am copying parts of it in support of what I said the other day about the importance of dealing with misalignments of the feet. It's a clear explanation of the effect of over-pronation (here called 'excess pronation') on the feet, knees, hips and lower back. The leaflet goes into detail about how excess pronation causes the various problems: I have just named them so as not to make this post overlong, but will include the section on plantar fasciitis at the end.


'The human foot was originally designed to travel on soft, natural surfaces like earth and sand. Unfortunately, instead of soft earth, we now spend every day walking and standing on unnatural hard, flat surfaces like pavements and floors. These surfaces force our feet to roll over to gain ground contact and our arches to flatten. Rolling over of the foot, or 'excess pronation', is believed to affect over 50% of the population.
Interestingly, although the foot rolls inwards, often the shoe will wear excessively on the outside edge of the heel. This is because the foot normally lands on theoutside edge first, and consequently rolls over causing excess pronation as a compensatory motion.

Just like the tires on a car, poor alignment of the feet can cause wear and tear to other parts of the body. Excess pronation often disrupts normal knee function and hip alignment and increases forces on the muscles in the lower back. Subsequenly, excess pronation can cause a wide range of common complaints, including heel pain (plantar fasciitis), knee pain, lower back pain, tired, aching legs, flat feet, metatarsalgia, Morton's Neuroma, corns and calloses, bunions, shin splints, achilles tendinitis, and ilio-tibial band syndrome.

The answer is to treat the CAUSE of these complaints, not just the symptoms. By restoring the lower limb's natural angle with orthotics we can align the feet and body posture to their neutral position and take away the cause of these problems.'


Here is the section on plantar fasciitis:
'Heel pain is commonly caused by rolling over of the foot (excess pronation). As the foot pronates, the arch collapses and the muscles and supporting structures are forced to stretch and elongate. This puts stretch (traction) and strain on the ligaments running from the heel to the toes. Orthotics re-align the foot, reducing the traction forces on the ligament, taking away this common cause of heel pain.'


My own introduction to orthotics actually came 30-odd years ago, when I was having knee pain. It was due to damaged cartilage (ski-ing injury), but over-pronation was aggravating it. My then-chiropodist casted me for orthotics, which, after a break-in period, resolved the problem (until 20 years later when the cartilage finally tore in another accident and I had to have surgery, but that's another story).

My present orthotics were a major factor in my recovery from PF, so my personal experience over half a lifetime makes me an enthusiast for them. But as a Yoga teacher/exercise professional I also agree entirely with the explanation given above. Biomechanical misalignment of the feet can cause foot, leg, knee, hip and back problems and they need to be corrected. I am making this post for the same reason I made my last one: to encourage people whose PF has been caused by over-pronation to think in terms of correcting that situation with orthotics.

Custom orthotics are expensive, and as we know, there is unfortunately no guarantee that they will be correctly prescribed, casted, or made. Many people are justifiably angry at having paid a lot of money for a solution that proved not to be a solution. Perhaps the answer is to try over-the- counter ones, which are not such a huge investment, such as the Superfeet inserts that are available from Scott, or the PowerStep, which I believe Dr Z likes.

I would also suggest that anyone who thinks orthotics might be an answer for them but is reluctant to spend the money, investigate taping. Taping acts in a similar way to orthotics, reducing the strain on the fascia. If it helps, i.e. diminishes the pain, it will also, by 'resting' the fascia, provide conditions in which it can heal. And if taping works, it's an indication that orthotics, a more permanent treatment, will also work.

There are clear instructions for taping, with illustrations, in the heel pain book. Several techniques are given. I used the simplest, two strips of tape from the ball of the foot to the heel, and it was very helpful. Do try it. I'll be glad to help anyone who wants to try it but has difficulty with it. It's simple once you know how, but there are a few finer points that it helps to know!

But this post is now quite long enough.