As I have harped on before, mechanical problems like abnormal or excessive pronation can cause a myriad of issues from the foot and proximally. I love the Rule of 3 defined: It takes 3 issues to cause an overuse injury. Therefore, abnormal pronation can only be one third or less of the cause of problems, however for some patients it is more important than others. This allows us to look at injuries blamed on excessive pronation and always look for 2 other causes that we can reverse. So, what is our list of problems implicated in abnormal pronation? They are:
1. First Metatarsal Phalangeal Joint Pain
2. Sesamoid Injuries
3. Bunions
4. Second Metatarsal Phalangeal Joint Capsulitis
5. Metatarsalgia
6. Second Metatarsal Stress Fractures
7. Morton’s Neuroma or Neuritis
8. Hammertoes
9. Intrinsic Muscle Strain
10. Plantar Fasciitis
11. Anterior Tibial Tendonitis
12. Lateral sinus tarsitis
13. Cuboid Syndrome
14. Lateral Ankle Impingement
15. Posterior Tibial Injuries
16. Tarsal Tunnel Syndrome
17. Peroneus Longus Strain
18. Achilles Strain
19. Tibial Stress Fractures
20. Medial Soleus Strain
21. Lateral Knee Compartment Syndrome
22. Pes Anserinus Tendonitis/Bursitis
23. Patellofemoral Injuries
24. Anterior Cruciate Injuries
25. Medial Hamstring Strains
26. Iliotibial Band Syndrome
27. Piriformis Syndrome
28. Low Back Pain
So, our first cause of all of these issues maybe excessive pronation. Stop that Pronation with shoes upgrades, strengthening exercises, and custom foot orthotic devices and you will really help your patients. But, besides overpronation, add another cause that you can help to the prescription. With the treatment of 2 causes, you are really upping the ante on your chance for good results. Here I will add a possible 2nd cause in red, and you add another one. See that there are many causes of some injuries or deformities. When you get good at this type of stacked treatment, your patients will reap the benefits. All causes can have simple but helpful treatments, including icing for the back in Morton's neuroma pain, etc.
1. First Metatarsal Phalangeal Joint Pain--abnormal pronation, bunion alignment issues
2. Sesamoid Injuries--abnormal pronation, weak bone 2ndary Vit D deficiency
3. Bunions--abnormal pronation, 2nd hammertoe deformity
4. Second Metatarsal Phalangeal Joint Capsulitis--abnormal pronation, metatarsus primus elevatus deformity
5. Metatarsalgia--abnormal pronation, tight achilles tendons
6. Second Metatarsal Stress Fractures--abnormal pronation, metatarsus primus elevatus
7. Morton’s Neuroma or Neuritis--abnormal pronation, L4/L5 disc disease
8. Hammertoes--abnormal pronation, weak achilles tendons
9. Intrinsic Muscle Strain--abnormal pronation, weak intrinsic musculature
10. Plantar Fasciitis--abnormal pronation, tight plantar fascia in pes cavus foot type
11. Anterior Tibial Tendonitis--abnormal pronation, weak ankle extensors
12. Lateral sinus tarsitis--abnormal pronation, peroneus longus weakness
13. Cuboid Syndrome--abnormal pronation, peroneus longus and brevis weakness
14. Lateral Ankle Impingement--abnormal pronation, weak posterior tibial tendon
15. Posterior Tibial Injuries--abnormal pronation, weak posterior tibial tendon
16. Tarsal Tunnel Syndrome--abnormal pronation, low back disease
17. Peroneus Longus Strain--abnormal pronation, activities or shoes producing lateral instabilities
18. Achilles Strain--abnormal pronation, weak gastroc-soleus complex
19. Tibial Stress Fractures--abnormal pronation, low Vitamin D (transient or chronic)
20. Medial Soleus Strain--abnormal pronation, weak and/or hyperflexible soleus
21. Lateral Knee Compartment Syndrome--abnormal pronation, genu valgum
22. Pes Anserinus Tendonitis/Bursitis--abnormal pronation, prolonged downhill running
23. Patellofemoral Injuries--abnormal pronation, weak vastus medialis oblique
24. Anterior Cruciate Injuries--abnormal pronation, sudden stops or changes in direcion activities
25. Medial Hamstring Strains--abnormal pronation, tight hamstrings
26. Iliotibial Band Syndrome--abnormal pronation, tight iliotibial band
27. Piriformis Syndrome--abnormal pronation, weak external hip rotators
28. Low Back Pain--abnormal pronation, functional hallux limitus
