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Hyperpronation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by gendel99, Jul 19, 2011.

  1. gendel99

    gendel99 Active Member


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    Hi to all!
    I have question about difference between normal foot and hyperpronated. Where the border between this conditions? Donatelli defined "Excessive pronation means that the foot is pronating beyond 25% of the stance phase" http://www.jospt.org/members/getfile.asp?id=3800
    but this is dynamic definition, and what about static, when human isn't walk? But other authors think that 67% of stance phase of normal gait last pronation. Where and what is true definition?
    Thanks a lot for answers! :eek:
     
  2. Griff

    Griff Moderator

    If you are keen to categorise static feet into groups as you describe, then take a look at the Foot Posture Index.

    http://www.leeds.ac.uk/medicine/FASTER/z/pdf/FPI-manual-formatted-August-2005v2.pdf

    As far as a single figure/value which delineates a 'normal' foot from another (can't bring myself to say hyperpro...) then there isn't one.
     
  3. gendel99

    gendel99 Active Member

    Maybe term "hyperpronation" isn't precise... I mean excessive pronated STJ that we can see in flafoot condition
     
  4. RobinP

    RobinP Well-Known Member

    Good Save Gendel99! :drinks
     
  5. Rather than the term "hyperpronation", I prefer the term "heckalottapronation".:bang::cool::eek:
     
  6. gendel99

    gendel99 Active Member

    :
    :D:D:D:D:good:
     
  7. gendel99

    gendel99 Active Member

    But if seriously...
     
  8. gendel99

    gendel99 Active Member

    What about definition Donatelli? He was true? If "hyperpronation" is not good term, why it use in scientific literature?
     
  9. Donateli's book: Biomechanics of the foot and ankle was first published in 1990 as such it is not a peer reviewed article and is over 20 years old. When we look to old texts and papers we see many terms being used which are inadequate and/ or outmoded by todays standards.
     
  10. gendel99

    gendel99 Active Member

    What modern references do You recommend about this problem? Because I feel lack of knowledge is this area.:sinking:
     
  11. What problem?
     
  12. gendel99

    gendel99 Active Member

    Problem of precise definition of hyper- over- or excessive pronation. Maybe I don't knew about state-of-the-art definition...:confused: Maybe exist synonyms? What about guideline-when to correct this "observation" or when don't?
     
  13. efuller

    efuller MVP

    You want to put a number to it. The problem is which number and what is that number related to. Anything related to the position of the heel bisection is going to be inaccurate. Velocity of pronation may be interesting, but would require an actual measurement system.

    Some people use pronated foot when they mean flat foot, so you could use arch height and ignore the the pronation part.

    Why do you want to quantify pronation?

    Eric
     
  14. gendel99

    gendel99 Active Member

    It is generally recognized fact that excessive pronation of STJ is factor that play major role in lowering medial longitudinal arch from MTJ locking mechanism. Hyperpronation (over- uber- etc.) of subtalar joint can lead to anerior patellar pains, pelvis tilt and even degenerative changes in temporo-mandibular joint http://www.scielo.br/scielo.php?script=sci_pdf&pid=S1807-59322009000100007&lng=en&nrm=iso&tlng=en Subtalar arthroereisis correct this condition and eliminate low MLA.
    From this data logically make conclusion that we need in precise definition this condition from point of view of EBM. The exist indications subtalar arthroereisis based more on subjective criteria such as pain, restriction in activities etc. Science love figures and precise definitions.
     
  15. Excessive pronation = pronation beyond the physiologic range.
     
  16. gendel99

    gendel99 Active Member

    i.e. less 6 degrees in RCSP or 1/3 full ROM in NCSP?
     
  17. NO! The physiologic range will vary from individual to individual. I meant the range beyond which the joint is subluxed, dislocated etc. but I was being facetious.

    Any motion within the range of a given individual, be that 1 degree or 100 degrees, is just plain old pronation. Pronation: its a movement, not a pathology. There is no such thing as excessive pronation, nor hyper-pronation; it's just pronation. There is no delineation between good pronation and bad pronation or normal pronation and excessive pronation, there is just pronation. Get over it, it's called pronation.
     
  18. gendel99

    gendel99 Active Member

    What about Root's 2/3 supination and 1/3 pronation or 30 degrees total ROM of STJ? And what do You think about this article http://www.touchmusculoskeletal.com/files/article_pdfs/graham_0.pdf
    Maybe I am very drop behind from modern biomechanics:confused:
     
  19. What about them? Root wrote that book in the early to mid 1970's. It's wrong. Next...
     
  20. gendel99

    gendel99 Active Member

    And article wrote in 2010? Maybe You recommend for me some modern references because I get confused?
     
  21. It's an internet site. Is it not obvious that a joint has a range of motion and that any motion within that range is just motion, why should you need to have reference for that. If it helps: Spooner, S.K. 2011: http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=218866&postcount=23
     
  22. gendel99

    gendel99 Active Member

    :good::D:D What about evidence-based medicine? That all your evidence? It is not scientific discussion((( I can say that urine is the best method to treatment flexible flatfoot))) Reference: gendel99 2011
     
  23. Gendel, there is no evidence that the subtalar joint pronating beyond a certain degree, or at a certain velocity is injurious. Frankly, the concepts you are attempting to explore here are, at best, naive and outmoded. I can provide a reasoned and deductive approach to the statements I have made here and if I could be bothered I could also provide you with lots of references which support my conjectures. Can you?


    You might want to re-read the posts in this thread, what do you think every respondent is trying to tell you? Get over it.

    Basically, this is a subject which is very old hat, and to be honest I couldn't really care less about because I stopped thinking in these terms about 15 years ago. There is pretty much a whole chapter on the lack of substantive evidence linking pronation with injury in Nigg's book: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=59171 complete with lots and lots of references- knock yourself out.
     
  24. gendel99

    gendel99 Active Member

  25. gendel99

    gendel99 Active Member

    Meybe discussion is begining? If Root's biomechanics is outdated, what theory do You use now?
     
  26. Tissue stress.
     
  27. Another quote of the year nominee I think.
     
  28. gendel99

    gendel99 Active Member

  29. gendel99

    gendel99 Active Member

    In my country accepted that eversion of calcaneus is more than 6 degrees is pathologic. But I don't sure that it true...
     

  30. Please tell me you are not using subtalar arthroesis in anyone with more than 6 degrees eversion of the calcaneus in an attempt to treat temporo-mandibular joint dysfunction.

    I got your private message about access to literature in your country, I'll see what I can do. Just stop doing STJ arthroesis on people just because they've got a calcaneus which is everted by more than 6 degrees, please!

    Kevin, can you and I do a deal to get copies of your books to this gentleman in Belarus, they might just start a revolution there?
     
  31. gendel99

    gendel99 Active Member

    In my country subtalar arthroereisis isn't performed, because one implant is very expensive for patient. We are perform operative treatment when conservative treatment fails (stretching, orthoses), often we do Evans-Mosca operation (lateral calcaneal lengthening) or calcaneal-stop method. Indiacation such a eversion more 6 degrees we don't take as rule (don't worry:D). Simply it's count that eversion more than 6 degrees is pathologic and it need for treatment, though I don't prescribe any treatment, if symtomps is absent. Basic indications: severe deformity that don't cure by conservative methods in during 1 year with symptoms as the pain, fatigue etc., presents of ligamenthous laxity, (I talk about flexible flatfoot). I am try to follow up of modern information about children foot pathology, pediatric orthopedics, but we very lack in knowledge modern biomechanics.
     
  32. gendel99

    gendel99 Active Member

  33. Hey Gendel. I have to love your enthusiasm. :drinks

    You said

    And I presume that by this you mean that this
    Is NOT true.

    Firstly, one remember the scientific method. The burden of evidence is not to show that a proposition is NOT true, but rather that it IS. So the proof required is to show that more than 6 degrees, (or 5, or 7, or 17) is pathological. None such exists.

    However if you wanted proof that the 6 degree "rule" is untrue, here it is.



    This is the best distance runner, possibly of all time. There is a LOT more than 6 degrees of pronation there. Can we accurately describe this as pathological? Not by any standard definition, If running that far, that fast is a disease then its one I'd love to contract. Should we "treat" him, to change his gait? Perform surgery on him? No.

    Thus, how can we determine pronation as pathological based on degree?
     
    Last edited by a moderator: Sep 22, 2016
  34. gendel99

    gendel99 Active Member

    I agree with You Robert. I am prescribe treatment option only when symptoms exist. But... in foot surgical literature that I read, pay a great attention in correction hyperpronation of STJ in children with flexible flatfoot. Especially if deformity more expressed in coronal plane (i.e. calcaneal eversion more ??? degrees) prefer method is arthroereisis or calcaneal-stop method in accordance with Green's planal dominance.
    Question - how many degrees of eversion I must leave post op? On how many degrees I must correct this pathological condition? It's to avoid hyper- or undercorrection.
     
  35. efuller

    efuller MVP

    The main problem with this term hyperpronation of the STJ above, is that the problem is at the midtarsal joint. The midtarsal joint is less stiff. Yes, there is an interrelationship between STJ position and midtarsal joint range of motion, but call a flat foot a flat foot. And just because it's flat does not mean that it is not stiff.

    Eric
     
  36. efuller

    efuller MVP

    One of the complecations of the arthroresis is lateral column overload. Leave enough eversion so that the STJ can evert far enough to bear significant load. This one time where you can apply the concept of forefoot to rearfoot realationship. However, you cannot apply it by looking at just the numbers, but you can apply it with the concept. Suppose you had left a heel with 3 degrees of eversion to the leg, but there was a huge forefoot varus. The medial column would not reach the ground at the end of range of motion of the STJ and you would get lateral column overload. If there was a forefoot valgus then the medial column could reach the ground.

    Eric
     
  37. Clinical normal subjects, mean resting calc position = 7 degrees everted http://www.ncbi.nlm.nih.gov/pubmed/8580949
     
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