Hyperpronation

Insoles or surgery for everyone then!

Thats a useful study.

 

More studies:

Only 17% of 116 feet considered 'normal' (as defined by Rootian protocol): http://www.jospt.org/issues/articleID.1882,type.2/article_detail.asp

Only 15% of subjects stood in STJ neutral: http://www.jospt.org/issues/articleID.1747,type.2/article_detail.asp

Normal position at rest is slightly pronated (as defined by FPI): http://www.jfootankleres.com/content/1/1/6

 

Come on Robert... we have been over this before haven't we? You cannot assess how much eversion there is by looking at the heel counter of the shoe.
Sorry... off topic I know

 

True enough with any degree of accuracy. But then in terms of measurement we can't tell what they'll do dynamically by watching them standing still either can we?

I think we can make a good guess that that heel is everting a lot more than 6 degrees. Unless there is some wicked slop going on and his heel is staying vertical while his shoe everts around it...

 

I used to think the same, but look at the video from this thread- (from post 86)
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=58204&highlight=dieter&page=3
I do not think this is uncommon

 

Yeah, but if I was being pedantic Pete I'd say that you don't know what effect you cutting out the heel counter of the shoe had on the static heel position.... shoes lie, we all know they do, but you can't remove the heel stiffener and say that it's the same as the intact shoe... anyway, we digress.

 

You lost me, Craig.

Seems to me you are comparing two different conditions: 1) a foot in a shoe with its heel counter intact 2) the same foot in shoe with its heel counter cut away. In 1) we have no idea what the position of the rearfoot was. In 2) we know what position the rearfoot is in, but have no idea what cutting away the heel counter has done to the shoe or foot function compared to the intact shoe. Remembering that we have no idea what position the rearfoot position was in in the intact shoe, I'm not sure how you can draw any conclusion what so ever from this with regard to position/ motion of the foot between the two conditions. We only know what the foot was doing in 2) so how can we make comparisons between conditions?

Enlighten me, please.

 

As I understand if calc eversion isn't symptomatic even it's will 90 degrees we must do nothing? hyperpronation=pronation=maximally pronation=overpronation it is all physiologic conditions?

 

What is required are predictive models relating the degree of rearfoot eversion to pathology.

 

I'd say that I see a great number of feet in which I seek to invert the calc (or rather increase inversion moment on the calc). But I don't do so simply because of the number of degrees the calc everts. Thats not the basis for my intervention. A foot with a calc everted by 45 degrees will probably have problems right? Its those problems I'm seeking to treat / avoid, not the eversion of the calc. The sequellae to the position / functional pattern are what the patient worries about and it is upon those I base my decision to treat.

 

If logically think degree of eversion correlate with lowering MLA. Viladot describe 4 grades of severity flatfoot depend on footprint image. I mean if more eversion than more lower MLA and more severe flatfoot. I am true or not?

 

In terms of flexible flat-foot in children, the decision to treat or not to treat is somewhat contentious.
see this magazine article: http://www.lowerextremityreview.com...-treat-the-pediatric-flexible-flatfoot-debate

And moreover, lacking quality evidence.

 

Footprint analysis is contentious in it's own right, see: http://www.ncbi.nlm.nih.gov/pubmed/9542353 then: http://www.ncbi.nlm.nih.gov/pubmed/17475140

foot posture index might be a better screening tool, since it has been shown to correlate to dynamic function: http://www.biomedcentral.com/content/pdf/1757-1146-3-9.pdf

 

Radiographic evluation in children contentious too. Clinical interobserver reliability is similar... but where is more objective method to evaluation or maybe flatfoot is philosophic category))) I mean that lowerig of MLA and eversion is correlated- if more eversion than MLA is lower and flatfoot severe

 

Well, you got to start by proving that rearfoot eversion = pathology. And this one questions your contentions: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129964/

This one questions arch height as a predictor for injury: http://www.sciencedirect.com/science/article/pii/002192909390053H I could go on...

 

No. Excessive eversion=pathology. Isn't it?

 

No, there is no such thing as excessive eversion, unless we are talking about joint subluxation / dislocation. I thought we'd been over that :bash:. Now, which studies demonstrate causality between the degree of pronation and injury risk? For every study which shows a correlation between rearfoot pronation and injury (correlation is not = to causation) I can cite you at least one, if not two, which says it isn't correlated. SO where does that leave us?

a) Pronation is a movement, not a pathology.
b) Pronation can only occur within the physiological range of motion of the joint (unless such force is applied as to sublux or dislocate the joint). Thus motion within the physiologic range of the joint cannot, nor should not be given the suffix "excessive", "hyper" nor any equivalent; unless we are referring to motion which exceeds the physiological range of the joint in a given individual.
c) Such motion beyond the physiologic range can only ever occur through traumatic injury and exceedingly higher loading forces than should be encountered during normal ambulatory function.
d) There is, to my knowledge little, if any, evidence which links pronation as a causative factor in any foot pathology or lower limb pathology.
e) foot orthoses may or may not alter the degree of pronation at the rearfoot
f) even when foot orthoses don't alter the degree of pronation at the rearfoot, patients still get better.

 

Time to look at the world in a different way. http://www.formthotics.com/images/stories/Research_Papers/niggnewparadigm.pdf http://ptjournal.apta.org/content/82/4/383.full.pdf html

 

http://www.ncbi.nlm.nih.gov/pubmed/11310866
http://www.ncbi.nlm.nih.gov/pubmed/16919216
Too interesting articles

 

Nope, I just get a search engine from those links.

OK you've now changed the links. Gendel. I've kinda grown bored of this now. Good luck with your quest, I don't think we are going to see eye to eye, ever. Good luck with your future.

Knock yourself out:

• Cowen et al. 1993
– “these findings do not support the hypothesis that low arched individuals are at increased risk of injury”
• Wen et al. 1997
– “lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort”
• Kaufman et al 1999
– “risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion”
• Hestroni et al. 2006
– “our study does not support the hypothesis that anterior knee pain is related to excessive foot pronation.”
• Rome et al. 2001
– “The results demonstrated that traditional risk factors such as excessive foot pronation, ankle equinus, and body weight are not associated with plantar heel pain”
• Hogan, Staheli 2002
– “This study suggests that in the civilian population flexible flatfeet are not a source of disability. This study is consistent with previous studies and provides additional evidence against the practice of treating flexible flatfeet in children”
• Yates, White 2004
– “Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation”

Etc.. etc.

 

Thanks! Best regards! "Earth is round" (proverb - maybe not good translation in English) or "it's a small world". Maybe You recommend somth to me about modern biomechanics?

 

http://www.youtube.com/watch?v=SDP-TGE9AYs&feature=related 8:17 on the ground (Smith will get that one).

 

Neither of these studies investigated injury or pathology in any way, shape or form. Have I missed the point? Why are they interesting?

 

They interesting, because touch this topic, but... this http://www.ncbi.nlm.nih.gov/pubmed/18794588
http://www.wantagentc.co.uk/foot.pdf
http://www.sciencedirect.com/science/article/pii/S1356689X0700121X
http://atpracticeinsights.com/pdf_o...ics-What-Role-Do-the-Feet-Play-1311614775.pdf
http://www.vasylimedical.com.au/images/vasyli/Orthotics_and_Back_Pain.pdf
Kevin Kirby use term maximally pronated STJ it's the same hyperpronation or not? http://podiatrytoday.com/understanding-biomechanics-subtalar-joint-arthroereisis?page=1

 

Like I said, bored now. Four references, 14 subjects in total between them. Next.... Seems like you have an agenda and it doesn't matter what evidence, I or anyone provides to the contrary, you'll keep on believing what you believe. Like I said: good luck with your future, Gendel.

 

I don't have any agenda and I not biased... I want look into this problem and understand. This is all.

 

Not..

 

In court lawyer adduce proofs, don't only say that his client don't guilty.

 

Gendel

Give me your email address. I am in the final stages of writing a blog about this very subject. Once it is finished and live on my site I will email you the link for it. Although not much more to say than has already been said here, perhaps it will help clarify a few things.

Ian

 

Like Robert said, it is not for me to prove that you are wrong, rather for you to prove that you are right. Thus far, the evidence you've put forward, is frankly p!ss poor. "No agenda"- really? So where is your "proofs" that rearfoot eversion greater than 6 degrees is causative of pathology?

 

Simon
I did this with one patient to demonstrate a situation I have observed many times.
The calcaneus does not appear to to evert when resting or during gait. In this case there is no suggestion of excessive pronatory forces (at least in static assessment). However, when in his sports shoes the heel counter of the shoe everts dramatically. A traditionalist would assess the shoe and say 'aha... you pronate excessively'.:hammer:
So I took pics of him barefoot with a rough calc bisection, in his shoe showing that the heel counter is everted- then took a bandsaw to the heel counter- took another pic which showed the heel counter still looks everted (granted perhaps more so), yet you can see the bisect of the calc is pretty much unchanged from the barefoot condition.
I think the video shows that the heel counter is everting, yet the calc does not appear to be everting excessively.
True- this would not hold weight in a peer review journal (although I have seen plenty of articles in this journals which should not be...).
Can you not see this?

As for conclusions?
Well I believe that the problem this particular patient had was being created by the position his foot sits in his sports shoes. Although he had an unremarkable STJ axis position, his heel was sitting quite medially and the shoe was in effect acting like a increased lateral flare- leading to increased pronatory forces. The shoe provided negative support medially, and it got worse as the shoe got older and the heel counter broke down.
He went well with a pretty close fitting 4mm poly orthoses which essentially made his heel sit in the middle of the heel of his (better) shoe.
Are you enlightened?

 

Not really. If it ain't everting in the presence of a net external eversion moment, what does that tell you? The problem remains, you don't know what the heel was doing when the shoe was intact regardless of the barefoot (a third condition) or the cut-away shoe conditions- right?

And BTW, how do you know where his heel is sitting inside the intact shoe with or without the orthosis at any instant in time? Don't say by the wear pattern inside the shoe.

 

In my country it is "dogma" propose some professors,very many yers ago. But now many orthopedists (in Belarus absent podiatrists) still believe in this dogma. But I am not. Many of our doctors don't speak English, and don't read modern literature. Because modern only on English. Publications in Russian and Belorussian langvages bring very outdated information.

 

Bloody Hell Simon... don't now try and get me to think. Your question needs to be more leading.
Answer... you are at end ROM?

 

So.......

 

Due to I am ask to all users this forum about hyperpronation

 

I am lack in modern biomechanical knowledge! But some modern authors support term hyperpronation and I am confused...

 

Could be. What it tells you is that the internal moment is at least equal and opposite to the external moment.

Lets take your example of end of range, or maximally pronated. I drop a fat kid on the end of a see-saw (external moment); see-saw moves until it hits the ground (end of range). I keep loading fat kids on the same end of the see-saw, see-saw doesn't move, compression forces twixt see-saw and ground keeps increasing (internal moment).

I have a STJ which is functioning at end ROM pronation, I put them in a shoe which increases the external pronation moment, do I see a change in rearfoot eversion angle? No- unless it subluxes the joint. Have the external pronation moments increased in combination with the shoe, bet your ass. Have the internal supination moments increased? Got to have because the body has provided an equal and opposite reaction force somewhere or the joint would have moved... Bet you Newtons 3rd. Will the orthosis you introduced reduce the required internal supination moment by reducing the external pronation moment without moving the see-saw (changing the rearfoot position)? Yep. If the orthoses does move the see-saw, do we know that the external pronation moment has been reduced? Bet your mothers ass it does, either that or the internal supination moment has suddenly increased (or both). Does it have to move the see-saw to reduce the stress on the tissues. No, Sir: it doesn't.

Does that explain your observations?

 

A nice succinct explanation of kinetics and relationship to pathology. I use the seesaw explanation a lot myself.

I think it is important to remember that you can have a kinetic change without an observable kinematic change, but you can't have a kinematic change without a kinetic change. It is for this reason that before rigorous scientific testing practitioners came up with the idea that 'hyperpronation' is bad.

As for my observations? Well I was just demonstrating that eversion of the shoe may not mean eversion of the foot inside... the significance I would look at on a case by case basis