I’ve got flat feet; some call it fallen arches, but the most accurate term for my actual foot dysfunction is overpronation. Let me explain: While it is true that my arches collapse under the weight of my body when I step down on the ground, giving my feet a flat appearance, it is because of an anatomical malformation of my heel that leads to this gait dysfunction.
The malformation is called a rearfoot varus deformity, in which the heel (calcaneus) is excessively inverted (turned in medially) when the foot is maintained in its neutral position (for doctors or those with technical understanding, it can also be from a tibia which has formed in a bowed position [tibiofibular varum] and often a combination of the two). This is, by far, the most common deviation of normal foot motion during the gait cycle (how we walk). Because of the excessively inverted position of the heel, when the foot comes down onto the ground, at the phase of the gait cycle we call heel strike, the initial contact with the ground is on the outer edge of the heel (posteriolateral to be exact). **You can check on yourself by looking at your footwear, and if you see wear on the lateral or outer edge of the shoes, you likely have this malformation.
To compensate, the ankle joint (subtalar) must excessively pronate, or turn outward, to allow the heel to fully contact the ground. This, in turn, leads to a chain of dysfunctional, compensatory movements of the foot, ankle, knee, hip, and pelvis, which can lead to a number of pain disorders. And worse yet is that the stresses and strains of the associated structures can lead to degeneration and ultimately disability.
I will not address every dysfunction that can result from overpronation here, as there are many, but instead will focus on medial knee pain. When looking at the cardinal planes of the body, those that divide the body in halves, we see the coronal (frontal), sagittal, and transverse planes (see photo). For our purposes here, I would like to direct your attention to the sagittal plane which splits the body into left and right sides. We can also consider the split into medial (toward the midline) and lateral (way from the midline) sides. Thus, when talking about medial knee pain, we mean on the inner part of the knee, toward the midline. Because overpronation causes the tibia (shin bone) to rotate internally (again, toward the midline), it causes enormous stress on the medial knee. The twisting forces shear at the medial meniscus which sits in the joint between the femur and tibia and can ultimately lead to tears. Further, the excessive turning out of the foot/ankle during overpronation also causes stress to the medial knee ligaments, and so the medial collateral ligament (MCL) of the knee can be stressed and even sprained.
Knee pain is one of the most common conditions I see in my Los Angeles, Beverly Hills, and West Hollywood chiropractic practice. Although there are a few other knee pain syndromes associated with overpronation, medial knee pain (on the inside of the knee) is most frequently encountered. One study showed 77% of knee injuries analyzed was due to faulty foot biomechanics.
While the immediate pain for any injury must be addressed by the practitioner to give relief, the underlying cause must also be addressed. In cases of medial knee pain caused by excessive overpronation of the foot, the long-term solution is being fitted for custom orthotics. Orthotics are shoe inserts customized to each patient’s unique anatomy, which provide support for the heel (rearfoot) or ball (forefoot) of the foot.
In the case of rearfoot varus deformity, which I have, a rearfoot posting is placed on the orthotic underneath the medial foot. This allows the heel to meet a surface (the posting) sooner than having to excessively pronate to meet the ground. Because overpronation is reduced, due to the rearfoot posting, the stresses on the medial knee are also reduced, and the problem is solved. Along with therapy and strengthening exercises, the pain should be resolved relatively quickly.
One major note: Patients often ask if there is some form of rehabilitation exercises that might work as a substitution to orthotic care, and my quick answer is always no. A rearfoot varus deformity is an osseous abnormality; in other words, it is anatomical and thus not changeable without surgical straightening (which means “not changeable”). The only way to correct this condition is to accommodate it by custom contouring a surface to allow noncompensated movements of all associated foot and ankle joints. I have had patients say, ‘My yoga instructor says I can correct this with yoga therapy….,” or, “I’ve heard I can fix this with Alexander technique…” My answer usually is, “Well, I mean, you can try, but I doubt it…” Both those techniques are useful – I am a long-time yoga practitioner, and it has helped me resolve many physical dysfunctions and ailments – but they will not resolve a rearfoot varus deformity. Just remember that the longer you wait to correct this dysfunction, the more at risk you are for tearing your medial meniscus or spraining your MCL.
Rearfoot varus deformity leading to overpronation during the gait cycle and causing, among other things, medial knee pain, can be corrected with custom orthotics and a solid exercise program. You can get medial knee pain relief rather quickly by addressing it this way. A good sports chiropractor can be of great service in both treatment and fitting you for custom orthotics. If you are in the Los Angeles, Beverly Hills, and West Hollywood areas and have pain on the medial or inside part of the knee, then do not hesitate and come get you feet, ankles and knees evaluated. Sooner is better than later.
