Can Varus Wedges Aid in Diagnosis and Treatment of Pronation Syndrome?

As podiatrists, we know that subtalar joint pronation is a normal function of the foot (with a similar motion described for the wrist). The foot pronates as you hit the ground creating good motion to absorb shock and loosen the foot to adapt to the ground. Therefore, pronation is a normal and necessary function for the body.

I just ran a workshop for 6 students at the California School of Podiatric Medicine at Samuel Merritt University. Two of these students had excessive pronation, where the motion of pronation led to significant arch collapse and knee instability. One of these had instability limited to the lower extremities. But, the other student also had trouble with his hips and back, where the foot pronation destabilized the entire body. Therefore, if the pronation motion is too much, too prolonged in gait, or too rapid to decelerate, symptoms can occur from the foot up. Since there are over 20 symptoms tied to the pronation syndrome, I find patients tend to pick on their individual weak spots. One excessive pronator can present with posterior tibial tendonitis, another plantar fasciitis, another knee or hip pain, up to the spine and upper extremities. 

What does this have to do with varus wedges? In my experience, a ¼-inch varus wedge makes a typical 4 degree change in the pronation for a patient. The varus wedge can be just a heel wedge, but will not help as much for a runner when they go up on the balls of their feet. Athletes in general present to my office complaining about their knee, ankle or foot. But, I like to talk to them about other problems they have, to either a lesser degree, or significant past problems. They may have had serious bouts of plantar fasciitis, shin splints, Achilles tendinosis, etc, but just not now. 

One of my patients presented with posterior tibial tendon problems and was very pronated. OTC arch supports and one pair of custom orthotic devices in the past were either painful to wear or did not fit into her shoes well. We spent some time over the next year designing comfortable, but stabilizing orthotic devices. Over the next year I remember her counting over 10 areas in her body, mainly lower extremity, that did not hurt anymore (they were all part of this pronation syndrome). 

Therefore, if you have some symptoms, or if your patients have symptoms, that you think could be tied to this syndrome of over pronation, apply a varus wedge as small as ¼ inch in the heel only to one pair of shoes and see if the symptoms improve. It could be as vital as an MRI. 

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com. 

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.