This is going to be a short one. As indicated before on my social media, this one is on the feet. Foot examination is a big part of my assessment with patients presenting with lower extremity pain and often back pain. Of the many dysfunctions of the feet that could cause pain anywhere along the lower extremity, a pronated foot often steals the lime light. While there are definitely problems that can be associated with excessively pronated feet and has been well established in the literature, I must point out that the word ‘excessive’ is important here. When I first started looking at the body not just as individual parts but as a unit together, the idea of regional interdependence was a game changer.
However, I was quick to jump on the bandwagon of blaming pronation for everything- shin splints, tibial stress fractures, ACL injuries, hip issues, global warming, oil crises (a bit too much, I know. Just my attempt to keep this as light reading). Remember that pronation is a regular part of the gait cycle during the suspension phase and also is a normal physiogical movement of the body. It is really the ‘excessive’ pronation and medial arch collapse that we should be worried about without demonizing foot pronation.
Apart from generally eyeballing movements for foot positioning during different movements like running, walking, squatting etc I like the Navicular drop test to assess ‘over pronation’/ medial arch collapse. Here’s a video of how I perform it.
[wpvideo BoYFsycQ ]
If the difference between the two points is >10mm then the test is considered positive.
I’m keen to read your thought on this subject. Do you often use this test? Any other tests you like to use in your assessment? Would you like that featured on this blog? Feel free to share your thoughts.
For those of you who are wondering what an excessively pronated foot has got to do with other lower leg problems (not you of course, you know this all to well), its might be useful to understand how problems at the feet might cause problems upstream at other joints, its called ‘regional interdependence’ and this is just one example. Understanding this is paramount. More on this in the next blog. Until next time
Abhijit Minhas PT
(BPT, MS, CMP, FMT)
- Vinicombe A, Raspovic A, Menz HB. reliability of navicular displacement measurement as a clinical indicator of foot posture. J Am Podiat Med Assn 2001;91:262-8\
- Flynn, Timothy. User’s Guide to the Musculoskeletal Examination. Evidence in Motion, 2008. Print.