Gary Moller: [DipPhEd PGDipRehab PGDipSportMed(Otago)FCE Certified, Kordel's and Nutra-Life Certified Natural Health Consultant]. ICL Laboratories registered Hair Tissue Mineral Analysis and Medical Nutrition Consultant.

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Monday, July 08, 2013

Correcting foot pronation (collapsing arches) with corrective exercise (Updated)




Wow!  345,000 YouTube views and climbing, this is one of the most popular and controversial video topics I have ever produced.  Pronating feet (Feet that tend to splay out and for the inner arch to collapse) is probably the most common biomechanic fault we ever get to see.

Conventional treatment for pronating feet invariably consists of the fitting of orthotics which are special shoe inserts that are designed to alter the mechanics of the foot.  These inserts can be expensive.  The most expensive pair I have come across so far, came to whopping $940 (including consultations).

In my opinion, most orthotics are unnecessary, often difficult to get used to, generally don't work and end up creating more problems than they fix.  Restricting natural foot mechanics with a shoe insert may cause a "clumping" walking and running style. New injuries, affecting the shin, knees and hips, may develop by the insert transferring the shock wave of foot strike further up the legs.  Orthotics are like crutches in most cases.  Reliance on any kind of crutch, for longer than a week or so, causes further weakening and increasing reliance on the crutch (dependence).

The long term solution for weak feet lies in improving the balance of strength between the intrinsic foot muscles and the muscles of the lower leg - as well as improving posture.  Unfortunately, this process takes a long time and involves breaking old habits such as standing and sitting with one or both feet splayed out like a duck.  This requires patience and persistence which is a threatened species in the quick-fix, "Give me a shot Doc" environment of today.
Pronation is not all bad as some experts would have us believe.  Pronation is a natural shock-absorbing function that feet are designed to do.  We are fiddling with millions of years of adaptation if try to fix excessive pronation by preventing pronation by the use of restrictive orthotics.  Instead, we would be much wiser in our actions by focusing our attentions on enhancing the function of the foot, including facilitating healthy pronation.  Healthy foot function is developed by strengthening the feet and improving body posture overall.  In the end, pronation is only a problem when the feet are weak and the posture is poor.  And we should not ignore excessive weight being a further cause of collapsing feet!

Habitual slumping when walking, running and standing is one of the worst things a person can do for their feet. When a person slumps there is a chain effect from the base of the skull to the feet.  In the case of the feet, the typical compensation to slumping is for the feet to splay outwards, causing excessive pronation.  The counter to sloppy posture is walking, running and standing tall with the feet shoulder width apart, knees slightly unlocked and the feet pointing forward, slightly pointing out.  Think of having a bungee cord fastened to the top of your skull, lifting your body up and keeping the spine straight.

The next step is to get about barefoot at every opportunity on natural surfaces like grass and sand.  Here, in my office, I never wear shoes and get about in a pair of sporty anklet socks.  Barefoot, especially on natural surfaces, strengthens the feet and trains the reflexes.

Support postural training with exercises that strengthen the "anti-gravity" muscles of the body - The back, gluteal, thigh and calf muscle.  The most effective and basic exercise for this is the "Lift and Press" which consists of lifting a weight from the ground, to the shoulder and then pressing it above the head.  Balance this with exercises that stretch the muscles that prevent us from standing straight - The chest and hamstring muscles in particular.

If you are overweight then it makes good sense to lose some excess kilos by assuming a "healthy diet" and a programme of daily exercise.  Strong, healthy feet  are central to an effective weight loss programme and the exercises to strengthen the feet and improve posture can be an integral part of an exercise-based weight loss programme.

If there is to be a concession to orthotics principles, it is the fitting of a flexible heat-moulded inner sole (Formthotics) which allows normal foot movement while giving some support when the weak or exhausted foot bottoms out at the peak of the foot strike.  Although I have always had strong, flexible feet, I love the shock absorbing comfort of these inner soles and would not be without them when running and hiking.  I also have the Formthotics Low Profile in my cycling shoes.

Interestingly, this kind of innersole is mostly unavailable in shoe shops nowadays - other than my website.  Their disappearing off the retail market coincides with the widespread introduction of "strategic partnerships" between sports shoe companies, retailers and professional foot clinics.  Here's an example of this.  

So, you go to a shoe shop, they get you to trot on a treadmill, or do some other test of foot function, tell you that your feet pronate excessively and recommend that you consult a foot specialist who will fit orthotics, paid in part, by ACC or an insurer.  If you are seeing a foot specialist, you will be directed to a particular retailer to get suitable shoes to go with your brand new orthotics.  The retailer no longer stocks these self-help heat moulded inner-soles. This is how it seems to work nowadays. It is therapy that does little to improve foot health, other than giving temporary relief, while contributing to blow-outs in health-care and insurance costs.

To my surprise this e-book and video on how to strengthen excessively pronating feet has attracted some vehement criticism from some quarters.  Despite this, I have not felt compelled to retract or modify anything said and demonstrated.  This is because the criticism, to date, has had no credible basis and can only be seen as pathetic attempts by people who have little interest in the health of their patients and who employ bully-boy tactics to protect their lucrative meal ticket.  A meal ticket which I think has been abused as a therapy.






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