Biomechanics and pronation

[trickytiger]

A question for those in the know:

Is it possible or probable that overpronation can be primarily occurring in the later stage of a footstrike? Here's the specs, and my issue. Warning- a little long-winded.

I've got a semi-permanent case of iliotibial inflammation. Most of the time it is unnoticeable to mild. It's only in my right leg, and the primary symptom is tightness and pain at the point where it attaches to my fibula, and a little to the lateral side of my knee. It's definitely tight all over. I stretch it frequently, and work on keeping strength in my tensor fascia latae (sorry for any mangled spelling). The primary cause is probably my mild scoliosis- my pelvis is rotated slightly counterclockwise and forward (ie my butt sticks out a little) around the axis of my spine (from my perspective) which creates a slight functional leg length discrepancy, although technically the legs are identical in length. I have pretty good flexibility front-to back in my legs and back, but pretty horrible flexibility on ANY lateral motion.

I have normal arches in my feet, but they are also narrow and flexible and I definitely overpronate when walking. When running, I've been videotaped and watched- and I am primarily a midfoot striker- I don't land on my heel. However, my foot flares out behind me after footstrike (think duck-footed), and I've got the classic dual set of calluses on the medial side of my big toe and met head. Most insoles and motion-control shoes are designed to control overpronation for heel-strikers and for the back of the foot. However, I seem to be mostly overpronating in the FRONT. (is this still called overpronating at this point?). Plus, I don't fit classic motion-control running shoes that well. They tend to be wide, meaning my foot swims around inside, and at 125 pounds I don't compress the midsole enough for the devices to really do their job- I end up sort of running on top of the shoe, if that makes sense. My current solution is a pair of berry Superfeet (slightly more flex to them then the classic green which hurt my metatarsals when running) and a pair of Asics Kayanos. On the bike, I have Crank Bros Candies pedals for a little more freedom in the "float" and the same berry Superfeet. I feel the same symptoms biking as I do running.

My real question- could my tight IT/hips be more of a factor in my pronation pattern then my feet? Should I be focusing on trying to solve what seems like perma-tightness instead of trying to monkey with shoes and insoles? Can you really make headway on structural issues or am I mostly going to be doing damage control?

[KnottedYet]

I have posted insoles for folks whose main issue was forefoot rather than hindfoot.

If your dorsiflexion is limited, that can cause whip callousses regardless of hindfoot varus or valgus. Tight ITB tends to hang out with tight calves.

The iliotibial hoopla could be caused by the pelvis or by the foot. (which came first, the chicken or the egg?) I'm doing a little literature search project RIGHT NOW on foot posture and its effects on pelvic dysfunction. Hit up http://scholar.google.com and search "pelvis" and "overpronation". Pretty cool stuff.

I'm thinking you've got all the foot goodies (superfeet, shoes, etc) just fine, and you know what you need to stretch, now you need some posting. But my bias is always toward feet. :)

(BTW, I worked with an ATC once who *swore* that tight ITB were caused by overpronation, and treated ITB stuff almost entirely with medial wedges.)

[teigyr]

Interesting. I know nothing really but I am very unflexible (think running in formative years) and have whip callouses. I had never heard that term before but it is SO appropriate!!!

My PT is treating me with stretching exercises and orthotics. It is so beautiful when I walk or run in the orthotics, my feet go straight ahead and there is no turning. But I think I'm different in that when I walk I turn after heel strike. When I run I vary but a lot of that is to do with the orthotic experimentation -- I have them for a bit then go back in and she changes/adjusts. I do know that she thinks part of my stride problems are due to lack of flexibility.

I'm just happy to know that other people have those callous things!!! I always feel so bad when I get pedicures, the salon has more work with me than others.

[emily_in_nc]

Pardon my ignorance, but what is a whip callous?

Thanks!
Emily

[Wahine]

You have the foot stuff under control from the sounds of it. YOu could also have some forefoot posting as Knott suggested.

I would also focus on external rotation stretches for the hip, sitting cross legged on the floor and pushing the knees down towards the floor would be a good place to start and the clam exercise for strengthening of the external rotators is a good idea. I'll try to post a link later but if you google "clam exercise" you'll get lots of hits.

[trickytiger]

teigyr- Yeah, at work I see a lot of runner's feet, and a lot of them have the same calluses- especially women. Another big clue is if your big toe is "drifting" away from midline and towards your other toes. Look on the bright side- at least your feet show that you're active!

Thanks Wahine and Knotted- although I KNOW I need to increase the flexibility in my hips- it's a bit of an uphill struggle. Ah, well, I'll try a one-woman experiment to see how much improvement I get. You would think, since I spend all my free time volunteering at PT clinics, that I would get the hint. :rolleyes: And Knotted- maybe someday I'll track you down to talk geek about insoles.

[teigyr]

Pardon my ignorance, but what is a whip callous?

Thanks!
Emily

A whip callous (at least what I think it is) is a callous in the center forefoot. When I walk, especially barefoot or in sandals, my foot turns at that point. If I'm wearing sandals and do a lot of walking, that spot can be so painful that it hurts to walk the next day. It's a circular kind of callous and is very deep.

The things you know :D

[KnottedYet]

The whip callousses I look for are at the margin of the big toe and margin of the ball of the foot. Looooooove finding those critters, cuz they tell me a LOT about how someone moves.

If I see a callous under the 2nd or 3rd toe (in the ball of the foot) my first thought is "dropped met head." Loooooove finding those, too.

What I don't like is chickies who get regular pedicures, cuz they get the callousses buzzed off and so I have NO CLUE what's happening long term when they walk.

And Tricky - I've been sending patients to you by name at your place of employment, telling them to get Superfeet or shoes. Have you noticed any upswing in requests for your expertise?

[teigyr]

Um some of us get them shaved off because they're ugly. No worries, they come back. And to be honest after they are gone, our feet hurt worse because there's no protective barrier. I don't think my PT looked at it one way or the other but she seems savvy so maybe she did.

[KnottedYet]

I would bet she did. Ask her what she thinks!

<I wasn't criticizing pedicures, really. I like them myself. But they do destroy important evidence.>

[OakLeaf]

Looooooove finding those critters, cuz they tell me a LOT about how someone moves.

Knotted, give! I have a big callus on what I guess you'd call the lateral margin of the ball of my foot, on the left side only. (I would have characterized it as the lateral aspect of the MTP joint, but I don't really know.) I have to keep it shaved otherwise it grows very large and painful.

I know I have lots of issues with my body mechanics, and I'm working on it with Pilates and Chi Running (yes, custom orthotics in the interim, although honestly I think they're aggravating that callus and my bilateral achilles tendinitis) - but what does this callus suggest to you? THANKS!!!!

[KnottedYet]

a callous on the pinkytoe side of things suggests to me that your orthotics are making you over supinate, unless you've always been an oversupinator. Or that you are wearing curved-last shoes when you should be wearing straight-last shoes (which is more likely).

But I'd really need to see you walk and look at your whole foot/ankle/leg to know what is going on.

There's a really cool series of pictures used by Gary Gray PT, that show callousses and what they indicate. Cool stuff. It's gotta be on the internet somewhere!

Have you asked your orthotist why you are getting callousses? Did the orthotist get to look at your shoes as well?

[kdskaggs]

Hi,

I'd love to hear the advice you receive because I am your other half! I have the same symptoms you have, except that they are on my left side. I wear orthotics to correct the pronation and even had knee surgery a few years ago because I tore a plica in my knee doing lunges. The lunges were perfect form, according to my trainer, but perfect for me wasn't perfect to him. Because of my pronation, "perfect form" tore my knee up.

I recently started getting weekly massages and this seems to help the tightness some. I am also receiving acupuncture to help with the tightness. Acupuncture has probably been more helpful than massage therapy. I started wearing my orthotics with my Sidi's to see if they would help the tightness but honestly, I haven't noticed a difference. I usually wear a heal lift in my left shoe but don't in my bike shoes because I don't pedal with my heal so it shouldn't make a difference either way.

My chiropractor acts like I am such an odd case but here I have a twin! Our symptoms are nearly identical and we even wear the same running shoes!

I'm looking at new bikes and would love to know what to look for that could help my ITB tightness.

Kenda