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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About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Are Formthotics any good for foot problems that require specific treatment?

"I just watched your youtube article on Formthotics, they seem to be just off the shelf products and not specifically for a persons foot, ankle knee or back problems. Problems that require specific treatment."

Frank
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Gary:
Thanks for your inquiry Frank and good question!

Some of the Formthotics are definitely off-the-shelf and take no fitting other than being placed inside the shoe.  The Forthotics Active and Shock Stop, on the other hand, are heat moulded to fit the unique shape of the wearer's feet.  The beauty of the Active and Shock Stop is that they support the feet while not restricting normal, natural foot mechanics.

Here is the link to my range of Formthotics inner soles.

Rigid orthotics alter foot mechanics in ways that I consider to be highly undesirable.  Unless there is a deformity, such as from birth or a traumatic injury, I consider the fitting of orthotics to be unnecessary and undesirable for the vast majority of active people.

Orthotics may possibly reduce a person's foot, ankle, knee or back problems but may not for long and may cause other problems down the line.  If a foot is not allowed to function as an energy absorber and regenerator, then that energy must be transmitted elsewhere when the foot strikes the ground - that means more stress further up the line affecting structures like the Achilles, the lower leg bones and even the knees, hips and back!

By not being able to regenerate that energy into forward drive during the push-off stage of the stride, the runner must expend more energy in maintaining a given speed.  You can always tell when a runner wearing orthotics is running besides you because you can hear them hitting the ground hard with an excessive heel-strike with a style that is more akin "clumping" along than floating along effortlessly.

In my 30 years in this kind of work, I have yet to encounter a pair of orthotics that could not be replaced by a combination of foot and postural exercises and running drills.  The most expensive orthotics I have thrown in the bin exceeded $900.  I did this without hesitation.

If the feet are not functioning as they should the answer is a far cry from orthotics which serve only to enrich the person doing the fitting and making the wearer all the poorer financially and as a fleet-footed athlete.

The solution lies in strengthening the foot muscles and re-educating posture and running form.  This means exercises in addition to running and getting a good coach who is familiar with running drills to improve leg strength and running form.

The most common foot fault, by far, is excessive pronation (foot must pronate, by the way - that's what they do to absorb energy during foot-strike!).  This may be countered by regular practice of the exercise in the video here.



Formthotics are very useful, replacing the existing shoe sole to provide a custom-moulded inner which stops the foot sliding and slamming about in the shoe while providing cushioning to prevent the arch from completely bottoming out as the foot muscles tire.  They do not restrict natural function of the feet.

I have Formthotics Shock Stop in all of my running shoes.  I love them and find that fitting a new pair into an old pair of running shoes is sometimes just as good, if not better, than going out and purchasing a brand new pair.

If you are not convinced about what I have said, then I suggest you invest $50 in a pair and try them out.

But please ensure that you do the foot exercise in the video!

_______________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Running Shoe construction - Have we sould out to the shoe companies?

"Recalling that your sister was a barefoot runner early in her career, I wonder about your thoughts on minimal running shoes. I can see valid points on both sides of the argument."


Photo: Lorraine and our late father, Gordon Moller, circa 1976, training in the Central North Island forests (Pinedale).

Note the rough terrain. The light shoes are conducive to nimble footwork. This terrain meant every foot strike gave varied stress on the feet and ankles and was quite soft on the knees and hips.

Heavy, over-constructed shoes would only lead to clumsy footwork and consequent injury - mostly from falls and ankle sprains.


"I had hip surgery July 2008 for labral tear induced by a well meaning therapist, on a totally fine hip, to impress me with her work and refer patients! Ouch. I have to vary my activity widely. The greatest bulk of my exercise time is in the twice weekly 2.5 hour strength training sessions. With one more shorter strength session, a couple hour hike in the mountains one day and a long stationary bike ride other days.

One day a week I allow myself the luxury of running for an hour. I don't want to lose that last bit of my running soul and have to be very careful given the hip surgery and the 3 preceding knee surgeries.

Occasionally I set aside my Asics Gel Nimbus in favor of my old Nike Free 5. Today I felt lousy before my run but once again I was surprised when I ran my usual course in just over 56 minutes - a minute faster than my last couple of year PR and 2-3 minutes faster than usual.

Have we sold out to the shoe companies? Have they stolen our running souls? (all inherent puns and double entendres intended)"
Michael

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Gary responds:

(Readers might gather that Michael is a doctor who loves to run).

"The human foot is the result of millions of years of evolution. The shoe companies want to change the design of the foot straightaway. Running in the cumbersome boots that jam the display shelves of the typical running shoe store is akin to John McEnroe trying to play tennis with a baseball bat"

Gordon Pirie

I weighed a pair of Lorraine's Mizuno Run Bird shoes which helped her win the Osaka Marathon circa 1987 and a pair of heavier modern running shoes. The Run Birds are of absolute minimal construction and weighed in at just over 100 grams per shoe. That is really light for running a marathon on hard pavement! A pair of my modern Asics off road shoes were almost three times that weight.

If you are running for an hour, you are probably raising and lowering a shoe about 30cm or more for each meter run. That's about 10,000 times. Which means you are raising the shoe 3,000 meters in height. According to my calculations: The total weight being lifted and lowered one meter in height is about 300Kg worth for the 100 gram shoe or about 900 Kg for the heavier shoes. These calculations do not include the energy cost of accelerating and decelerating the shoes. (PS: I rushed these calculations, so my apologies if there are any errors).

Now, try this:

• Get a 10 Kg weight, a bench one meter in height and set yourself up with a heart rate monitor. Then:
• Measure resting heart rate standing still. Then:
• Lift the 10 kg weight from the ground onto the bench and then lower. Repeat this non-stop for 30 repetitions.
• How much did your heart rate go up and how long did it take to do the 30 repetitions?
• Work out how far you could run in that time at that heart rate.
• Rest for 5 minutes and then repeat the exercise, this time doing 90 repetitions.
• Now extrapolate these results to running a marathon.

Phew! Give me the light shoes any day!

Heavy shoes, or any extra weight, including a water bottle, back pack, watch or heavy clothing all energy-sappers.

So, the message here is to run light and that definitely includes your shoes.

My favourite running shoes are a pair of super light Addidas racing flats. I have removed the inner soles and replaced these with a pair of heat moulded Formthotics Shock Stop inner soles.

But what about injury risk? Very little of my running is on hard and boring pavement nowadays - I run over tracks that are generally rough and often very steep (That's Wellington for you!). I seldom run longer than an hour and do my longer exercise sessions on a mountain bike.

This works well allowing me to compete in a number of sports injury free at 56 years of age.

I hope this kind of answers your question - I am sure you can gather where I stand on this matter. Minimalist.

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I am training for the Oxfam Trailwalker and have leg and shin pain

Dear Gary,

I'm training for Trailwalker in Taupo in April and need some advice!

I've been walking since Oct, initially 2-3 hours one day at the weekend; added in weekdays and built up to 46km/wk 2 weeks ago, without any problems at all. Last week I did just 29km then worked 15hrs Saturday and 15 hrs Sunday on my feet all day (work shoes, not running shoes; indoors). On sunday I started to notice pain in my right anterolateral shin on walking.

Today I went for a walk and this was much worse, particularly on concrete and stepping down a step onto onto my right. Since finishing walking it is still pretty sore in the anterior lower shin on dorsiflexing and relaxing my right ankle.

Also my left tibialis posterior I think is newly painful today (sore when i set out this afternoon then settled through my 9km walk, but now I'm done, especially noticeable on actively inverting a dorsiflexed foot. Passive movement is fine). (I had trouble with this once >10yrs ago). (I am 29).

I had stopped wearing my orthotics because they were giving me blisters but I will be putting them back in and putting up with blisters from now! I've also watched your video for tibialis posterior exercises - how many of these and how many times a day do you recommend?

I was planning to put in a lot of training the next 4 weekends and increase the distance each weekend - should I do what I can within limits, or do you think I need to back completely off until it is quite resolved? Any other recommendations to help me be able to complete the walk in April?

Thanks very much for your advice,
Christina

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Gary:

Christina, here is some quick-fire advice:

• Find an experienced sports massage therapist and get about half an hour of massage of both legs, concentrating on the sore spots.  Repeat the massage only once every 5 days and gently stretch inbetween daily.  
• Get a pair of Formthotics Shock Stop Inner Soles and wear them in all your shoes, including work shoes.  commence easy walking the day after the first massage.  Read the articles about massage on this website.
• Ensure your diet is up to scratch.  Please read the many articles about nutrition and fitness on this site - there is a ton of information here.
• You might want to try a few glasses per day of Balance Ulitmate Recovery.  This has many ingredients that assist recovery and healing.  If you have a job that has you on your feet all day, then take a pot to work and have it instead of tea breaks.  This supplement will also double up as your sports drink during the Trail Walker.
• Walk only every second day (Training walks).
• On the other days, ride a bike swim, do aquajogging, paddle a kayak.
• Do the Tibialis Posterior exercises every 2nd day.  Do sets of about 30, go do something else for 5-10 minutes, then repeat another 30 and do this about 4-6 times.  Build up to this over a few weeks by doing just 3 sets initially.
• Concentrate on doing just three long walks per week and only walk as far as you are certain your legs will tolerate sufficiently that you are recovered to do the next training walk without risk of inury.

Enjoy the Trail Walker Chrisitina!

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Hallux Rididus/Limitis - should I use orthotics?

I am a 31 year old semi-competitive runner and a police officer here in the US. I have been diagnosed with hallux limitis (stage 2). I am awaiting orthodics which I am told will take the stress off my great toe. I recently had surgery for a sports hernia which I believe is from a gait adjustment to avoid pain in my big toes. I have I have a family and have been really agonizing over giving up my running for good. However, I have implemented your massage technique today and am amazed at my increase in range of motion already. Would you suggest I still use the orthodics or just continue with the prescribed course of action on your web sight? I tried a 4 week comeback recently but had to stop due to big toe pain (causing a gait change again and painful hips!!). Any help would be appreciated.

Sincerely, Matt
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Gary Moller advises:
Matt, You are too young to retire from running. I never bother with orthotics which prevent the foot from working as nature intended. The nearest I go is Formthotics which are a heat moulded inner sole that supports the feet without interfering with their natural actions.

My advice is to give the massage plenty of time to take lasting effect. Three months doing the massage every 3-4 days with a break in between to allow recovery before ther next session.

Take a glucosamine and chondroitin supplement that has MSM added. Take the maximum dose every day for at least 3 months.

Get about barefoot as often as possible, including walking in sand at every opportunity. Look for a pair of shoes that simulate barefoot running, like the Nike Free. Start by walking in them and then wear them on runs of less than 30 minutes.

Resume running right away keeping within current pain limits and never running two days in a row - you must have at least one rest day between runs - even the short run - until you are completely recovered. Run a circular lap course rather than an out and back one, since Murphy's Law dictates that your toe will seize at the furthest distance from home. Run over varied terrain, preferably off-road trails. If you can't find anything suitable, come to New Zealand and train here.

What can be done about sore feet from new running shoes?

Dear Gary,
I have purchased a new pair of Addidas running shoes. They look and feel very nice but I am getting very painful soles when I run. It is agonising. Please help!
"R"
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Gary Moller comments:
Dear "R", I know all about the distressing discomfort that you describe. I purchased a new top of the line Nike shoes a few weeks ago and suffered the same painful problem during my first run in them. The culprits were the inner soles that came in the shoes and the problem was solved in a few moments.

Picture: Rip out the stock inner soles and replace with Formthotics.

The problem you describe is very, very common and is most likely due to local ischaemia. Now, don't worry about the big word: Ischaemia means lack of blood to an area causing burning pain, cramps and sometimes much worse.

When you run, circulation of life-giving blood is enhanced by the "muscle-pump": Each time a muscle contracts, stale blood is forced out and back to the heart, thus augmenting the work of the heart. When the muscles relax fresh oxygenated blood flows into the soft belly of the muscle - and so the process goes with with each cycle of contraction and relaxation.



Where the muscle pump effect is interfered with, such as when lifting and lowering weights without a breif break in muscle tension between lifts, the muscles will quickly tire and the ischaemic "burn" is felt by the lifter.

A similar pumping effect happens in the feet while running. Each time the foot strikes the pavement the blood engorging the sole of the foot is forced out and upwards by compression of the tissues. Fresh blood flows into the foot during the recovery phase of the running phase. Now, the runner gets into big trouble if the foot is firmly encased in a shoe that does not allow the foot to fully decompress during the recovery phase. Failure to decompress the foot does not allow fresh blood to flow into the bloodless foot. The consequences can be:

• Burning painful soles and feet
• Rapid tiring and failure of the foot muscles causing
• Loss of foot posture causing
• Loss of running form and efficiency causing
  
• Injury to the feet, lower legs, knees and even the hips and low back

Prevention centres around enabling the foot to decompress during the recovery phase of the running action:

• Carefully remove the inner soles of the shoes and replace with Formthotics Active and fit carefully according to the instructions that come with them (Available from www.myotec.co.nz)
  
• If the shoes are tight or low cut, such as for cycling, then use Forththotics Low Profile instead.
• Formthotics mould to the shape of your foot while allowing the foot to decompress - something that few sports innersoles allow to happen.
  
• Toss out your thick and juicy sports socks and replace them with a pair of thin cotton socks that do not encapsulte the feet like a pair of embalmed mummies.
• Lace the shoes so that they are loose over the forefoot while being firm about the upper foot and ankle area.