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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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!

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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.

I have been having arch pains in both feet, after running

Hi Gary,

I am currently looking to train for the Oxfam Trailwalk in April 2011. I have been having arch pains in both feet, after running around a 5 km block. They have been coming on near the end of the run about 50% of the time recently. I have proper Asics running shoes (which were neutral), but I'm wondering if they don't support my arches properly?

As a bit of background, my mother also has occasional arch pains in her feet, so it may be something genetic. Every few months or so, I get random pains in my arches just from normal day to day activities. Generally, if my arches are feeling sore, I run my feet over a curved wooden roller and the pain tends to go away straight away. Another factor, which I don't know if it is related or not, is that I am bow-legged.
However, I am concerned with what will happen to my arches over the 100km walk if they do not have correct support. I don't want them to compress. Plus I don't want to be in pain from the first 10km.

What do you recommend?

I am thinking of going to a podiatrist, however am also keen to see if there are other solutions or cheaper options than actual orthotics, if that is what is recommended.

Thanks for your help

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Gary:
If you find that the foot muscles are getting excessively tired during exercise then it is likely that the problem lies in your calf muscles.  The muscles of the calf support the foot via a series of strong tendons.  If the muscles in the calf which activate these tendons are weak and tire quickly, then the intrinsic muscles of the feet will be excessively stressed and will tire quickly.

Seldom are these problems genetic.  It is more likely that you were born with the same nutrient profile as your mother and you may have adopted some of her habits, including posture which can affect foot health.  A stooped posture, for example, may cause the arches of the foot to collapse inwards.  This is best corrected by standing up straight, keeping the feet straight, rather than splayed out and please practice the exercise in the video that is above.

It is possible that your shoes are too tight and thus restricting blood flow.  This may be exacerbated by wearing thick sports socks such as Thorlos which can cut off circulation to the sole of the foot.  Experiment with thin socks and lacing so that the forefoot is a little loose while still snug at the ankle.

Orthotics are a complete waste of money for the vast majority of cases of foot and leg pain and do little other than give temporary relief at the cost of longterm dependency.  In fact, they can cause more harm by transferring the foot-strike shock wave further up the leg, causing ankle, calf knee and even hip pain.

Orthotics may cause more injury by transferring the foot-strike shock wave further up the legs

The lower leg is a marvel of biological engineering and we are arrogant to feel we could do a better job than Mother Nature.  Rather than create a dependence on crutch-like orthotics, it is better to assist the legs with doing their work better than ever before.  This is achieved by doing the foot exercise above to strengthen and rebalance the muscles of the lower legs and feet; Get about barefoot as often as possible, including walking in sand and on grass; Ensure a nutrient rich diet as guided by a Hair Tissue Analysis; And consider fitting a pair of Formthotics Shock Stop inner soles.

Finally, ensure that your training programme has rest days between long or tiring training sessions and make sure there is a very, very gradual build-up over several months.  You must give your body, including feet, time to adapt to the increasing workloads.  Always have alternative activities such as swimming and cycling interspersed over the week between walking.  If ever you feel an injury developing, switch entirely to these alternatives until healed.  This way there is no interruption in your overall buildup of fitness.

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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.  Please give me your support by subscribing to my free email updates. Please shop at my Online Store. Please encourage your family and friends to do the same. While we may not always be able to compete with the big operators on price, we aim to more than compensate through personal service!




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London Marathon 2009 - Feedback from a Happy Camper

Hi Gary,

Well I've managed to finish in one piece, so I'm quite relieved! 2.53 was the final time. I held 4min kms comfortably for the first half (halfway in 1.25ish), but tiredness (or more precisely lack of fitness) came on quite quickly around 25km, so it was grovelling time from there to the finish.

Photo: Lorraine Moller winning the first London Marathon: An all women event, organised by Wellington, New Zealand, resident, Kathryn Switzter.  The intention of this event was to demonstrate to the IOC that the women's marathon was an event worthy of inclusion in the Olympics.  Female runners were finally allowed to run the Olympic marathon at Los Angeles 1984 where Lorraine finished 5th.  The London Marathon has gone on to become a truly international spectacle.

Very sore quads in the last 10km, so I'm going to need a wheelchair for the next few days! Pleasingly the calves held up well. Got moments of tightness every now and then, but to my huge relief I was able to run through it and it passed. So fingers crossed that I've got over these calf
problems and can look forward to some training this winter.

London marathon is an incredible event. I would put equal with New York. Every marathoner must do one of these events in their marathon career.  Masses of people, both running and supporting. Superb organisation.

I can't thank you enough! You got me to the start line (when 4 weeks ago I had given up all hope) and I was able to run all the way. Thank you, thankyou, thank you!

I will be back to see you when I return. I suspect my quads will need a lot of work over the coming months.

Cheers, Todd

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Gary comments:

Despite not being able to run with jsut four weeks to go, I never doubted that Todd would make the start line: It was only a matter of how fast he would be able to run and the condition he would be in at the finish.

Treatment up untill he came to see me consisted of a number of months of physiotherapy plus massage.  Interestingly, his calf injury was suspisciously close to the fitting of $400 orthotics which I replaced with a pair of Formthotics Shock Stop.  Treatment was simple:

• Formthotics Shock Stop inner soles.
• Foot pronation exercises.
• Replacement of various nutrients that he appeared to be low in and that might be slowing healing and reducing exercise capacity.
• Massage of the calf muscle and all the running muscles.

To my advantage is a lifetime of intense sport and a dozen sub-3hr marathons myself; so I knew what was involved which sure does help with zeroing in on the problems and sorting them out without wasted time, effort and money.  

Far too much medicine, including most orthotics is hit and miss stuff.

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I am suffering pain in my foot arch near my heel

Hello Gary;

I am writing to you from Turkey. I am a male of 49 yrs old and I am in good health and posture. I am 1.85 meter height and weight is 85 kg.

I am suffering from a pain in my left foot arch near my heel (but not exactly on the heel). This arised suddenly.

I found yr mail address fro yr blog site, I downloaded the "Correcting the pronation" e-book.

I went to a doctor and he gave me an orthopedic cushion to be put in my shoes. For this, he just scanned my foot and took the picture of my feet placed me on a special plate when walking. (for both feet)

As treatment, he gave me stretching exercises to strengthen calf, achilles tendon to be done in the morning and nights. He suggested me to do these exercises during 6 wks and he will check situation afterwards.

I am now researching the main cause of this.

Other possible factors:

My father has rheumatoid arthritis.

I am not a well sportive person. I was not doing sports in my life.

I am sending the scanned pictures of this report and the picture of my feet seen at the back.

My question is:

1) Why this didn't appear on my other foot?
2) What is the probability of disappearing this with stretching?
3) Am I Going to do the stretching exercises all my life?
4) What else do you suggest?

Thanks & Best Regards,

T
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Gary Moller comments:
"T", my first impression of your feet is they are very good - much better than many I have seen in my time.

While your feet do pronate somewhat I would not be at all concerned about this. The exercises you are practicing should help. You need do little more other than perhaps to fit some Formthotics Active innersoles into your shoes. These will give some additional support to the feet during a long day on your feet.

I suspect that you may have strained one of the muscles of the foot arch that attaches to the heel bone. The cause may not always be all that obvious; but can be the result of a slip, stumble or doing an unusual amount of exercise, or even standing about all day in the wrong shoes. Since much time has elapsed, I think the best course of action is to find a strong Turkish masseur who can locate the painful areas in the feet and massage them progressively over several sessions until the areas are soft, supple and pain free. This therapy, when combined with stretching and strengthening exercises may give lasting relief. The exercises in my E-publication on correcting pronating feet is perfect for the feet that I can see in the photos you have supplied. Of course, as the years go by, you must keep up the exercises. These become increasingly important as one gets older.

Take every opportunity to walk on grass and sand barefoot.

Please let us know how you get on and wishing you all the best "T".

Shoes contribute to weak feet and poor posture

".... I believe shoes are a contributing (e.g., not primary) factor in the development of postural distortions. The foot was designed to walk barefooted which allows the intrinsic muscles of the foot to function and maintain their strength (as you walk, the toes are able to grasp the sand or soft ground). In shoes, especially with hard innersole surfaces, this cannot occur. The toes cannot function as they do barefooted, and hence the intrinsic muscles of the foot become weaker. This is compounded by the fact that many healthcare providers prescribe arch supports to help reduce the symptoms caused by a weak foot. Unfortunately, this only increases the problem. For example, for you put a cast around the knee, the muscles atrophy. Similarly, when you put an arch support underneath the foot, the intrinsic muscles of the foot atrophy." Professor Brian A Rothbart, Podiatric Physician and Surgeon
Photo: Lorraine and Gary Moller ~1958 Putaruru.
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Gary Moller comments:
I went barefoot the best part of my first 16 years, playing soccer, rugby, running cross-country and even hockey without shoes. My first 5 mile run was barefoot along a country road with a barefoot mate. My sister, Lorraine, did the same and her strong feet carried her to an Olympic bronze medal in the marathon at age 38.

All of my children were raised as barefoot as society would allow them. When a strethch and grow was given as a gift, the feet were cut out with a pair of scissors. Shoes were mostly open sandals and the toe boxes were spacious and the soles flexible. No tight stockings were allowed and bed clothes were light and loose so as not to distort the growing feet. All of my children have strong and flexible feet. They are set up for life by what we did for them in their first years.

The key to keeping toes comfy in the cold weather was not to swathe them in thick socks but to keep the central body core warm as toast so that excess heat was radiated away by the little pink toes. To understand more about this, please read my e-book about Hypothermia and Sport.

The photo to the right shows the feet of a child who has been raised mostly barefoot and the feet of an adult who was raised with restrictive footwear and stockings.

Professor Rothbart is dead right when he comments about arch supports. This is why I am generally opposed to the ise of orthotics to correct foot postural problems with these. Read my e-book here for more about this topic. I have yet to see a single case where orthotics are justified.

Simple solutions to injury and training problems

"Hi Gary, just a quick note to let you know how I have got on with the formthotics I got from you. Myself and a friend had planned a 3.5hour run for last night. I was a bit sceptical before the run about how I would go with blisters etc. However with new shoes a full size smaller than previous pairs, the formthotics from you and new thin running socks my feet were great, no problems at all which is amazing and a first - I am so relieved. Having come through that run with nothing other than tired legs I am going to commit myself to the Rotorua marathon. Thanks for you advice, I might have spent a small fortune lately but to run for over 3 hours and not even a hint of sore feet is well worth the $$ for me."

Gary Moller comments:This keen female runner and cyclist in training for a marathon was suffering badly from a number of foot problems for which there seemed to be no easy solutions. Her prospects of making the start line for the Rotorua Marathon in good condition were diminishing by the day. As you can gather she is now a very satisfied customer.

As is often the case with most injuries of non-violent causation, the solutions can be remarkably simple and almost always of the "self-help" kind. Seldom, if ever, does a drug, injection, scalpel or expensive orthotic resolve the problem. Most often the solutions lie in a person's training structure, their coach, doing corrective exercises, small adjustments to their equipment and even just changing one's shoes, socks and inner soles!

If you have injury or training issues that bother you, please do not hesitate to contact me and I will do my best to assist with finding a lasting solution.

Ankle pain in older runners

Gary
I have been running since I was a boy; I won my first school title when I was 10, and since then I have run ever since. In April this year I turned 40, so have been running for 30 years, reasonably consistently.
Whilst I've had my share of reasonably serious injuries (many self-inflicted, but a number being managed as I get older), my biggest concern is after a 1 hour plus run on hard surfaces, my feet and/or ankles just hate it, and I spend the whole run, waiting until it's over. I did a easy 75 min flat run with my mates yesterday, and I just couldn't wait until it was over. In terms of shoes, I wear Asics 2110 at home and work, so a reasonable shoe.
I am actually worried for the first time ever about how this might affect my running. Any suggestions of what I can do? Likely treatment or supplements?
Regards
"B"

Photo: sometimes, foot and ankle problems are easy to spot; more often, the trouble is not so obvious and, unfortunately, there are no single, quick-fix solutions.
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Gary Moller comments:
Thanks, "B", for consenting for this going onto the web: The problem you describe is one of the most pressing faced by "ageing" runners. If not resolved, the runner may be forced into giving running away and we can't have that happening, can we?

The best approach to dealing with foot and ankle pain is to tackle the problem from several different angles and hope that one, or a combination of the following suggestions have a beneficial effect:

• Run, step and bound barefeet weekly in sand. This is what the great coaches of old, like Percy Cerutty, always had their athletes do as part of their training. When Otago athletes of the 1970's were at their height of national prominence, coaches like Alastair McMurran had regular bounding sessions up the massive sand dunes of the Otago Peninsula (I had the dubious pleasure of doing a couple). This type of training helped develop and maintain strong, flexible feet and ankles. This type of training is all but forgotten nowadays and much to the detriment of runners. This type of training is all the more important as we get into our 40's and older. Joints, muscles and tendons thrive on being flexed and extended through their full range of movement. On the other hand, repetitive and restrictive movement, such as running on pavement is not good for feet and ankle joints.
• Try different shoes and fit semi-orthotic inner soles. Although I prefer Asics myself, an obvious measure is to try a few different makes and models. The change can be remarkable when it comes to ankle pain. I have 4 different pairs that I rotate, including a pair of Asics designed for off-road running. The semi-orthotics I recommend are Formthotics Active which can be purchased here. A measure as simple as an inner sole change can give relief.
• Do your ankle and foot exercises. If your feet tire as a long run progresses, the arches begin to drop, shock absorption diminishes and the outer borders of the ankle joints may be bruised which you may really feel upon getting out of bed the next morning! Here is the link to the E-Pub on the subject. Of course, these do not replace sand dune running!
• Get your leg pulled! Yes, get a strong massage therapist to get stuck into your feet and ankles, working on mobilising all of those tight sinews and joints, including the main ankle joint. Manipulate a child's supple feet and the contrast with a typical runner's feet will shock you. So get into it and don't neglect the sand running which flexes the feet better than any masseur.
• Take Glucosamine, Chondroitin and magnesium daily. Joint food preparations help guard against arthritis and may even help reverse the process. If the feet and calf muscles are tiring prematurely and cramping, this may be partly due to magnesium depletion which is a near universal problem with older runners. If the muscles tire, then the feet cease doing their stability and shock-absorbing work, thus throwing abnormal strain on the structures of the ankles and feet.
• Run off-road. Buy a pair of shoes designed for trail running and do all of the long runs on trails. The soft surface and constant adjusting of foot and ankle placement is what those feet were designed for and they love it! Take care at first: your lack of flexibility and dulled reflexes from all that road running means you need to take care initially not to stumble or trip. The foot and ankle pain may be stirred up initially; but should diminish and disappear as the feet and ankles strengthen and regain flexibility with regular trail running.
• Do cross training. Aqua-Jogging done properly and cycling are my favourites. These enable the ageing runner to continue to develop a huge cardiovascular reserve while sparing muscles and joints that have already given more than a lifetime of faithful service!

(For more about this topic, type "ankle" into the search box to the upper left of this page and search this blog.)