SOME MEDICAL FACTS
Description: Over Supination.
Supination of the foot occurs when your weight rolls onto the outer edges of your feet. Over supination occurs when your rear-foot doesn’t roll in far enough, or seems to roll outward. When this happens, your foot no longer properly absorbs the shock of each step. As part of a normal stride, your rear-foot should roll inward slightly after your heel hits the ground, cushioning the impact and helping you adapt to uneven surfaces.
NOTE: If the bio mechanics of your foot are a slightly off, it can throw off the alignment of your entire body. Excessive or over supination of your feet will eventually lead to:
- back and hip pain
- stress on the knee
- ankle injuries
- inflammation of the sole, called plantar fasciitis
Over Supination: or under-pronation, is common among people with high arches or tight Achilles tendons (the stretchy bands of tissue that connect your calf muscles to your heels). As part of your normal stride, your rear-foot should roll inward slightly (pronate) after your heel hits the ground, cushioning the impact and helping you adapt to uneven surfaces. You then push off the big toe.
Supination is part of every stride you take. However over supination places extra stress on your foot and leg that can cause problems elsewhere. This is because the shock wave from your heel strike isn’t absorbed properly and the outside of your foot bears the full force of your step’s impact.
Supination is usually a result of an inherited problem with the structure of your foot. In other words, it may run in families. Supination may also be caused by weakness in certain muscles of your foot, ankle, and leg. The lack of strength may be a result of:
- improper shoes
- misalignment of the body
- prior injury to the foot that damaged your tendons or muscles
Wearing rigid, tight shoes all the time can cause problems. And since your feet are the foundation of your body, foot problems can throw your whole body out of alignment. An excessively supinated foot can’t adapt to the surface it’s walking on. This means that the surrounding bones and muscles have to work differently to maintain your posture and balance. Over time, this can lead to tension in various parts of your body, including the calves, knees, hips, and back. Prolonged tension often leads to injuries.
Over Supination: may have secondary effects on the lower legs, such as increased rotation of the tibia, which may result in lower leg or knee problems. Under pronation is usually associated with many overuse injuries in running including medial tibial stress syndrome, or shin splints, and knee pain Hintermann states, “Individuals with injuries typically have pronation movement that is about two to four degrees less than that of those with no injuries.” He adds however, that between 40% and 50% of runners who over pronate do not have overuse injuries. This suggests that although pronation may have an effect on certain injuries, it is not the only factor influencing their development.
Examine the wear pattern of an old pair of your shoes. We see normal wear on shoes toward the center of the heel and soul.
If instead, your shoes are more worn out on the outer edge of the heel and in particular the sole, you may be an over supinator.
These wear patterns can be easily seen when looking at the heel of a persons shoe from behind.
The best way to know if you’re a supinator is to undergo a gait analysis by a professional who is trained to diagnose issues with the feet. It will usually involve walking or running on a treadmill. The persons ankle will tend to roll to the outside edge Ref: Bone Structure Image to the right.
Other signs can include;
- heel or arch pain
- corns or calluses
- knee, hip, or back pain
- hammer toes, mallet toes,claw toes.
The specialized soft tissue at the heel functions as a shock absorber. The subcutaneous structure consists of fibrous lamellae arranged in a complex whorl containing adipose tissues that attach with vertical fibers to the dermis and the plantar aponeurosis.
The heel can absorb 110% of the body’s weight during walking and 200% of the body’s weight during running. The plantar fascia is a multilayered fibroaponeurotic structure that arises predominantly from the medial calcaneal tuberosity and inserts distally through several slips into the plantar plates of the metatarsophalangeal joints, the flexor tendon sheaths, and the bases of the proximal phalanges of the toes.
Dorsiflexion of the toes applies traction stress at the origin of the plantar fascia. A contracture in the triceps surae, a pes cavus, or a pes planus can increase the traction load at the origin of the plantar fascia during weight bearing activities.
Other anatomic factors that can have similar effects are overpronation, discrepancy in leg length, excessive lateral tibial torsion, and excessive femoral anteversion. However, overuse, not anatomy, is the most common cause of plantar fasciitis in athletes. The pain of plantar fasciitis is caused by collagen degeneration associated with repetitive microtrauma to the plantar fascia
An inflammatory response and reparative process can double the thickness of the plantar fascia, which is normally approximately 3 mm. Biopsy specimens reveal collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and calcification.
The heel pain can also have a neurologic basis. The tibial nerve, with nerve roots from L4-5 and S2-4, courses in the medial aspect of the hindfoot, through the tarsal tunnel, under the flexor retinaculum, and over the medial surface of the calcaneus. The calcaneal branch, arising directly from the tibial nerve, carries sensation from the medial and plantar heel dermis.
The tibial nerve divides into lateral and medial plantar nerves, which proceed into the plantar aspect of the foot through a foramen within the origin of the abductor hallucis muscles, which forms the distal tarsal tunnel. The first branch of the lateral plantar nerve changes course from a vertical to a horizontal direction around the medial plantar heel. It passes deep to the abductor hallucis muscle fascia and the plantar fascia and is the nerve supply to the abductor digiti minimi. The tibial nerve and its branches in the hindfoot can be involved with compressive neuropathies. A valgus heel can stretch in the tibial nerve.
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