Hyperpronation is a very common condition of excessive motion of the rear foot. This abnormal motion leads to deformity of the foot and potentially to the knees, hips, and back, etc. Even though hyperpronation is not a life-threatening deformity, it must be aggressively treated. The excessive pronation occurs with every step a person takes and leads to damage to the musculoskeletal system. This is why by the time most people reach middle age they begin to develop problems with their feet, knees, hips, back, etc. Estimations have been made that show by the time the average person has reached middle age they have walked 75,000 miles. If your feet are in good shape no problem, but if your feet are "out-of-alignment" sooner or later the effects will be felt.

Hyperpronation of the foot is present at the time of birth. If a child has a flatfoot they will most likely never "grow" out of it as some have claimed. As the child grows they may develop so called "growing-pains" at night. There is no such things as "growing-pain" it is actually an inflammation of the lining of the leg bones. This occurs due to the excessive activity of the leg muscles to propulse the foot during normal ambulation. The leg muscles are working several times harder than normal. These muscles have to bring the foot to normal position (neutral position) and then lift the foot for the next step. If the child has been very active during the day, lots of running or playing, then usually that night after the trauma has stopped the pain begins. Later, the tissues will compensate or the child will decrease their activities and the pain will subside. Other times, shin splints will occur during running due to the same mechanism. There are many other symptoms of hyperpronation that are covered in Common Symptoms / Findings. You do not want to gamble with the mechanics of your child's body.

 

Currently, the treatment of hyperpronation of the foot is often ignored or treated inappropriately until symptoms appear and there is damage to the body. You don't have to have pain, symptoms or other secondary deformities to treat hyperpronation. As with any other deformity, the sooner treatment is initiated the better the outcome. Once hyperpronation is diagnosed in the foot, appropriate treatment regimen should be given to reduce or eliminate this condition to the best ability. As with any medical visit, treatment options should be discussed after a thorough history, physical examination, gait analysis, and other imaging studies. Every patient and every foot requires different needs.

 

Oral medications and/or physical therapy etc. do not address the underlying deformity, excessive motion of the talus on the calcaneus. These treatments are aimed at treating the symptoms, meanwhile the deformity is still present and with every step, further damage is developing. Some patients are given strengthening exercises, well, the muscles, tendons, and ligaments are already being overworked and we don't want to add more fuel to the fire. Sometimes in mild cases of hyperpronation this can give temporary improvement but time will prove it to be ineffective.

 

Many patients set out on a life long quest to find the "Holy Grail" of shoes that make their feet feel good. They usually end up with a closet full of shoes and their feet still hurt. Most patients finally discover that if they wear flat shoes the pain increases but if they wear heeled shoes/boots there is a relief to the pain in their feet, knees, back. The reason is that there is a decrease in the deforming forces acting on their body. To reiterate this deformity of hyperpronation is an intrinsic deformity and extrinsic measures are usually ineffective or reserved for mild cases.

 

Arch supports have been the 'gold standard' in treating abnormal foot motion. There is a wide range of devices from the cheapest possible material that eventually disintegrates to custom-molded orthotics costing hundreds of dollars. Sometimes this is all that is needed to bring relief to the individual. Most other times, there is temporary relief but followed by recurrence of the symptoms. There are also situations when the inserts actually lead to an increase in the symptoms or pain. The problem with inserts is that they are trying to prevent the arch from collapsing by pushing-up into the arch. This is an extrinsic treatment trying to treat an intrinsic deformity. Treating the problem from the outside when the cause and reason for the deformity is inside will not solve the problem. As we have previously learned, the abnormal foot motion occurs because of excessive motion of the talus (ankle bone) on the calcaneus (heel bone). External devices are not the most effective way to control internal motion. So even when wearing the custom-molded very expensive orthotic device, excessive motion will still occur leading to further deformity. There are many draw backs with the use of arch supports in treating this condition. Firstly, they are only effective if you are wearing them in your shoes, when you walk without wearing your arch supports damage is occurring to your body's musculoskeletal system. Women will have a difficult time finding stylish shoes to fit their inserts and may forgo wearing them. If you participate in an activity and are unable to wear your inserts, i.e. spring board diver, dancer, gymnast, etc., then this would not be the most effective treatment regimen. The orthotics aren't doing that individual any good. Secondly, many times individuals just don't remember to wear the inserts as much as they should or they get lost. Thirdly, the device needs to be replaced since it either wears away, or a different device is need to increase the correction of the deformity. These patient's are then left the rest of their lives trying to get replacement inserts, shoes, etc. to try and prevent the hyperpronation as best as possible.

 

Historically, if there was failure of the above to eliminate the pain or if there was a significant deformity a recommendation was made to perform various soft tissue and osseous surgeries to realign the foot. These procedures entailed tendon transfers, bone grafts, cutting and shifting of bone(s). Even with today's advances in foot and ankle surgery these procedures require up to 4 to 6 months of recovery. The overall goal of these procedures is to realign the talus on the calcaneus and thereby realigning the rest of the foot bones. There are many potential complications with performing these types of procedures and the recovery is long but there are times when this is still the only treatment option available for correction of the deformity.