Inman and Close coupled transverse plane oscillations to subtalar joint rotation. I believe normal vs abnormal pronation can be defined in terms of pelvic rotation.
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For me, normal and abnormal pronation its not defined like an hiperpronation movement: I think the key is in the aceleration or velocity of this movement and the moment in wich it is producing. The amount of pronation is in relationship with tibial rotation, legs, pelvis, femur, hip... but the these element movements will be more pathological when higher velocity they have and the incorrect moment in gait when they appear.
I suggest that normal and abnormal subtalar joint pronation can be defined in terms of transverse plane rotations of the pelvis.
Try this simple experiment:
- Stand up barefooted.
- Rotate your pelvis in a clockwise rotation maintaining foot to ground contact, in a relaxed position.
- Note that the left foot (subtalar joint) pronates and the right foot (subtalar joint) supinates. This is the closed kinetic chain coupling between the pelvis and foot that Inman published on.
- Now rotate your pelvis in a counterclockwise rotation, maintaining the relaxed foot to ground contact.
- Note that the left foot now supinates and the right foot pronates.
All this occurs automatically, without muscular contraction.
Observing patients with a plantargrade foot walk (no structural or functional abnormalities), for example, when the entire left foot is in in contact with the ground, it pronates while the pelvis is rotating clockwise and supinates while the pelvis rotates counterclockwise. This coupling pattern is defined as ‘Hip Drive Pronation’ (pronation of the foot follows the oscillations of the pelvis).
In my chronic pain practice, I see many patients whose subtalar rotation patterns have escaped Hip Drive Pronation. That is, for example, the left foot supinates while the pelvis is rotating clockwise.
Try this second simple experiment:
Stand up barefooted.
- Rotate your pelvis in a clockwise rotation.
- Concurrently supinate your left foot.
This requires peroneal recruitment (it does not occur automatically) and it produces a pulling (strain pattern) in the lateral compartment of the left knee.
This type of pronation pattern is referred to as ‘Gravity Drive Pronation’ and the reason(s) it occurs is a subject for another discussion.
There is a third pattern of subtalar pronation that results from malocclusions and atlas divergencies. That discussion would also be a subject for another discussion.
http://rothbartsfoot.es/RFSGaitAnalysis.html
http://rothbartsfoot.es/Gait_Analysis_PCFD.html
Pronation is a foot maneuver for GAIT and abnormal pronation is a bad alignment of lower body that limit and affect on GAIT.
Agree with all above, particularly Gomez. Abnormal or abnormal pronation is pronation that causes symptoms either in the footer above in the ankle, knee hip or back. In most cases the key to asymptotic pronation becoming symptomatic is the isolated gastrocnemius contracture. To be clear I am talking about acquired flatfoot deformity secondary to PTTD or a primary spring ligament tear, midfoot osteoarthritis and Charcot foot formation to name a few.
Agree with you James.
Any comments/observations on:
Stimated Brian Rothbart: these are a good question what you pose: sometimes is not necessary to have a soft tissue injuries to show abnormal pronation (for example, in childhood). And so many pacients related worsen their foot inclination (ie pronation) with age.
I think in my first example, the concept "planar domination" wich we have from birth, determinate the dynamic stress of soft tissues.
In the second example, laboral or life style situations can produce the musculoskeletal injuries without necessary bad skeletal foot orientation.
I agree Ruben.
Abnormal (gravity drive) pronation can be the result of an inherited abnormal foot structure (e.g., PreClinical Clubfoot Deformity) or a postnatal soft (connective) tissue injury that can result in abnormal pronation.
Abnormal pronation can also be described as any pronation occurring when the foot should be supinating
Hi Guido,
Your response is 'right on'.
Abnormal pronation is any pronation occurring in the foot when it should be supinating.
Anormal pronation is not defined in terms of degree of pronation, or the velocity of pronation, but rather in the TIMING of pronation.
- Hip Drive pronates the foot from heel contact to foot flat.
- From foot flat to heel lift, Hip Drive supinates the foot.
So by definition any pronation occurring between foot flat to heel lift is abnormal pronation.
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