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The response to the question below was authored by Marc Mitnick DPM

To pronate or not to pronate? That is the question.

by Barry
(Brisbane Australia)

Most articles I read about running shoes ( including here) always go on about over pronation and supination. But I always come away with the thought that these articles have been written for people who heel strike during their running gait. I heel strike when I walk - my foot lands heel first and then rolls through to the toes before pushing off - my walking shoes show wear in the big toe area and the outside rear of the heels. However - I land on the balls of my feet when I run and tend to touch my heels to the ground as the first part of my running gait and my running shoes shoe wear only on the forefoot part of the shoe.


So - how can one purchase running shoes from shoe stores whose staff seemed to be trained to mostly consider pronation?

RESPONSE

Hi Barry,

I guess the first question I have, is are you having any pain or any difficulty in walking or running? Everyone for the most part will either pronate or supinate in their gait cycle so that alone is not reason for concern. It only becomes a problem when there is excess in either type of motion.

<> This statement confuses me. Do you land on the balls of your feet or do you land on your heels? According to the above statement, you do both which of course is impossible.

By most of your narrative I envision a high arched foot that may or may not be flexible, in other words a high arched foot that may or may not pronate when you walk or run.

I say this because you mention you wear out your heels on the posterior outside portion; that is normal heel wear. That means when your foot comes down during "heel strike" your foot is inverted as it should be in normal gait. (People who excessively pronate will either wear out their heels on the posterior portion or the inside heel of
their shoe).

The fact that you also wear out your shoes by the big toe would be suggestive of a high arched or cavus type foot structure because in that type of foot structure, the first metatarsal, or first ray is plantarflexed relative to the second, third, fourth and fifth metatarsals. In other words it is in a more downward position compared to the other metatarsals, so you would normally create more pressure under the first metatarsal head which would cause your shoes to wear out in that area.

Now if you actually land on the balls of your feet when you run, as seen in sprinters, that may be suggestive of an equinus foot, which means you have a tight Achilles tendon and that as well can be seen in high arched feet.

Again, what this comes down to, are you having any issues either during walking or running? If you are at all concerned, perhaps a consultation with a podiatrist in your area might be indicated.

In general, high arched feet are poor shock absorbers and that is one of the components of gait; to absorb the shock of heel impact. In those instances one type of running shoe might be indicated.

If you happen to have a flexible cavus foot which is a high arched foot that pronates too much, a different type of running shoe would be indicated. Actually, if do happen to have this type of foot structure, an orthotic would be a better option then trying to find a running shoe to control your excess pronation.

Lastly, if you have a foot that just pronates too much and do not have a high arch, then an anti-pronator shoe may be all you need.

So as you can see, until you know what type of foot structure you actually have, it is difficult to make any suggestions, and then once again the question is raised, do you actually need to do anything (if you are not having any pain)?

Marc Mitnick DPM
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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center




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(items I prescribe in the office)


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics

Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics

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