Paper Review April 2018

Paper Review April 2018

We are all more than familiar with the term “overpronation”, as are many of our patients who have googled their foot problems! Some of us even try to be a little more specific with descriptions such as “abnormal-pronation”, excessive-pronation, and even “hyper-pronation”, when trying to explain the aetiology of our patient’s symptoms. This interesting paper takes us through the history and evolution of these terms and promotes thought for how we utilise them.

Defining excessive, over, or hyper-pronation: A quandary
Horwood, A., Chockalingam, N.  (2017).
The Foot. (31) 49–55

Overview:
This paper takes us through the evolution and advantages of human foot pronation along with a historical review of the terms pronation and hyper pronation. The uses of the terms used by clinicians to describe “too much pronation” have been investigated and findings suggest that there are no concise definitions. New definitions for hyper pronation have been proposed but the authors warn that these may still be “open to debate”.

What it all means:
Abnormal-pronation, excessive-pronation, over-pronation and hyper-pronation are all commonly used terms used by clinicians in both clinical and research settings. However, despite their long standing and widespread use, there are no clear classifications pertaining to abnormal, excess, over or hyper-pronation.

Key points:

  • The term pronation was first applied to the hand to describe the motion taking place to move the palmar surface to face the ground.
  • In the 1930’s, Morton first used the term “pronated posture” to describe the foot rolling inwards. He described the reduction of the medial longitudinal arch as a “pronation deformity”.
  • “Pronation”, “flat foot” and “eversion” are often confused.
  • It is unlikely that hyper-pronation can be given a quantitative scale because individual anatomy and activity changes the necessary range of pronation within the foot.
  • While more concise definitions have been proposed, these may still be open to debate until more information emerges in the future.

 
Proposed definitions for pronation:

Terminology Definition Terminology Definition
Foot pronation Motion of the foot articulations that allow the foot to become more prone to the support surface.
Foot hyperpronation A range of motion within the foot that makes the foot more prone to the support surface that is greater than that required by the individual to adjust to morphology or to adapt to the forces placed on the musculoskeletal system by kinetic and kinematic events within gait or another given action.
Hindfoot hyperpronation A range of motion of the subtalar-ankle joint complex that is driven primarily by moments of plantarflexion, abduction and eversion of the subtalar joint complex and dorsiflexion, abduction and eversion of the ankle joint. These motions are greater than that required by the individual to balance morphology, or adapt to the forces placed on the musculoskeletal system by kinetic and kinematic events within gait or another given motion.
Midfoot hyperpronation A range of motion of the joints of the midtarsal complex and lesser tarsus that is driven primarily by moments of dorsal gliding of the articulation and plantar depression of the bones of the lesser tarsus that is greater than that required by the individual to balance morphology or adapt to the forces placed on the musculoskeletal system by kinetic and kinematic events within gait or another given motion.
Forefoot hyperpronation Dorsal gliding of the tarso-metatarsal joints and increasing distance between the 5th and 1st metatarsal heads, so that the bases of the metatarsals take up a more plantargrade position that is greater than that required by the individual to balance morphology or adapt to the forces placed on the musculoskeletal system by kinetic and kinematic events within gait or another given motion.

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