BY IAN GRIFFITHS MSC BSC (HONS) MCHS


INTRODUCTION In an increasingly evidence based world, it has never been more important within the sports medicine field for our clinical terminology to be as accurate, descriptive and meaningful as possible. This should, of course, not exclude the re-evaluation of historical concepts to identify if they are still appropriate. A classic example of this is the change in our understanding of tendon pathology over recent years, and the subsequent change in the terminology now used (1). This article will review some of the literature regarding foot level pronation, and, in doing so, facilitate the conclusion that the term “overpronation” is neither accurate, descriptive nor meaningful, and should therefore be abandoned to the same scrapheap as “tendinitis”.


BACKGROUND


Pronation is simply a description of a normal joint movement which occurs in all three cardinal body planes (referred to as triplanar motion). Whereas this article refers to this motion in the lower limb, it is worth remembering that pronation is not isolated to the lower limb; the upper limb can, of course, also pronate – this occurs at the radioulnar joint, for example when checking your watch to see what the time is. At foot level, pronation is seen as a combination of abduction, eversion and dorsiflexion (when weight-bearing). This motion occurs at the subtalar joint, which is the articulation between the inferior surface of the talus and the superior surface of the calcaneum.


HISTORICAL ASSUMPTIONS OF NORMALITY The theoretically conceived reference for an ‘ideal foot’ is essentially still what many modern day biomechanical evaluations and management plans are dependent upon (2). This paradigm was first introduced in the early 1970s by Dr Root and his colleagues from the California College of Podiatric Medicine (3). The observations which they believed identified a ‘normal’ foot are seen in Box 1.


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OVERPRONATION: ACCURATE OR PARACHRONISTIC TERMINOLOGY?


This article examines the commonly used term “overpronation” and puts forward the case that it should be abandoned from the vocabulary of every sports injury professional who deals with lower limb pathology. Despite being one of the most frequently used terms associated with foot mechanics, the basis upon which it is used is nothing more than conventional habit, with next to no evidence supporting it as a medical concept. A review of the literature regarding foot level pronation is presented, and the historical assumptions of ‘normal’ (upon which most biomechanical evaluations and treatment plans are based) are challenged.


Feet that did not fit these criteria Figure 1: A foot in a pronated position


were then deemed as ‘abnormal’ with the assumption being that they may provide less efficient walking and running gait patterns, and be more prone to injury due to compensations that may occur during activity. Somewhere along the line, this information evolved into what became the cornerstone of most educational programmes on foot function: that we should function either in, or very close to subtalar joint neutral (the position when the subtalar joint is neither pronated nor supinated). It should be noted that this has never been suggested in any research, instead just gaining popularity within both medical and lay communities insidiously.


sportEX dynamics 2012;32(April):10-13


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