If the inner side of your shoes are especially worn, you could be overpronating. Excessive inward roll of the foot after landing, such that the foot continues to roll when it should be pushing off.
This twists the foot, shin and knee and can cause pain in all those areas. If you are an overpronator, you'll find excessive wear on the inner side of your shoes, and they'll tilt inward if you place
them on a flat surface. Knock knees or flat feet contribute to overpronation.
Pronation can occur as an overuse syndrome in active runners, where a great deal of stress is placed on ligaments and tendons that support the medial column. Obesity is another predictor for
pronation and deterioration of the medial ligaments and posterior tibial tendon due to excessive stress on these tissues. Acute Trauma can also lead to over-pronation when ligaments are torn or
tendon is ruptured. Once again this can lead to a collapse of the medial column. Arthritic conditions involving the knee joint when the joint is in varus (inner collapse) posture, this places the
center of gravity over the ankle joint rather than the foot causing undue pressure on the inner ankle.
In addition to problems overpronation causes in the feet, it can also create issues in the calf muscles and lower legs. The calf muscles, which attach to the heel via the Achilles tendon, can become
twisted and irritated as a result of the heel rolling excessively toward the midline of the body. Over time this can lead to inflexibility of the calf muscles and the Achilles tendon, which will
likely lead to another common problem in the foot and ankle complex, the inability to dorsiflex. As such, overpronation is intrinsically linked to the inability to dorsiflex.
Bunions, calluses and crooked toes may indicate alignment problems. So, it is important to ascertain the condition of a client's toes. Check the big toe to determine if the first joint of the toe is
swollen, has a callus or bunion, and/or looks as though it abducts (i.e., hallux valgus) rather than pointing straight ahead. Also, look to see if the lesser toes seem to "curl up" (i.e., the person
has hammer or claw toes). This may be indicative of damage to, or inflexibility of the plantar fascia caused by excessive flattening of the foot.
Non Surgical Treatment
Solutions typically presented will include physical therapy sessions, prolonged prescription drug regimens, occasionally non-traditional approaches like holistic medicine and acupuncture. These
options can provide symptom relief in the short term for some patients. However, these treatment methods cannot correct the internal osseous misalignment. Ligaments are not effective in limiting the
motion of the ankle bone when excessive joint motion is present. Furthermore, there is not a single, specific ligament that is "too tight" that needs to be "stretched out." The muscles supporting the
bones are already being "over-worked" and they cannot be strengthened enough to realign these bones. There is no evidence to suggest that any of these measures are effective in re-establishing or
maintaining the normal joint alignment and function.
Exercises to strengthen and stretch supporting muscles will help to keep the bones in proper alignment. Duck stance: Stand with your heels together and feet turned out. Tighten the buttock muscles,
slightly tilt your pelvis forwards and try to rotate your legs outwards. You should feel your arches rising while you do this exercise. Calf stretch: Stand facing a wall and place hands on it for
support. Lean forwards until stretch is felt in the calves. Hold for 30 seconds. Bend at knees and hold for a further 30 seconds. Repeat 5 times. Golf ball: While drawing your toes upwards towards
your shins, roll a golf ball under the foot between 30 and 60 seconds. If you find a painful point, keep rolling the ball on that spot for 10 seconds. Big toe push:
Stand with your ankles in a neutral position (without rolling the foot inwards). Push down with your big toe but do not let the ankle roll inwards or the arch collapse. Hold for 5 seconds. Repeat 10
times. Build up to longer times and fewer repetitions. Ankle strengthener: Place a ball between your foot and a wall. Sitting down and keeping your toes pointed upwards, press the outside of the foot
against the ball, as though pushing it into the wall. Hold for 5 seconds and repeat 10 times. Arch strengthener: Stand on one foot on the floor. The movements needed to remain balanced will
strengthen the arch. When you are able to balance for 30 seconds, start doing this exercise using a wobble board.