The importance of correct posture  

Posture is a topic that is important and it is worthy to look at. In general, proper posture reduces back and neck pain. Good posture is the proper alignment of your spine, head, and neck when you are standing or sitting. 

From the front, a straight line should follow your spine, with the shoulders, hips and knees at 90 degrees from that line. While standing from the side, the ears, hips, knees and ankles should follow that line. 

Proper posture helps reduce stress and strain on the muscles, ligaments and joints in the body. In general, muscles have to work harder to stabilize the body if posture is out of alignment. Decreased mobility is another issue as it is harder to move a body part with tight muscles attached to it. Proper posture also helps to prevent injury as the body is better able to adapt to uneven or sloped terrain.

Foot and leg posture

Healthy foot posture is important to maintain healthy feet and legs. 

When you see a Pedorthist, an assessment is done of your feet and ankles. This assessment helps to determine what bones, muscles and joints may be affected by the way you stand or walk.

What is supination? 

Supination is a word to describe rotation outwards on the body. For example, the rotation of the forearm and hand so the palm faces forwards or upwards. In relation to the feet and legs, it’s when they roll outward.

With foot supination, it is best seen from the back. Draw a line down the middle of your leg and connect it to the line on the back of the heel. “Normal” would be when the heel is in line with the leg. “Supination” is when the heel rotates outwards compared to the lower leg. This means your weight will be more on the outside of your foot when you stand or walk. 

Issues that can arise from a supinated foot are ankle sprains, shin splints, calluses, and pain in your heels and balls of your feet. A foot orthotic can help equalize the pressure loading on the bottom of the foot and can help make the ankle more stable.

Supination can also lead to pain higher up in the knees, hips and lower back as well. This is because when the heel rotates outwards, the lower and upper legs rotate out as well.

A supinated foot tends to lack shock absorption. Because of this, the best shoe choices have more cushioning in the sole.                                 

What is pronation?

Pronation is the opposite of supination. Instead of rolling outwards, pronation is rolling inwards. In relation to the feet, it’s when the foot is rolling inwards.

Common issues that can arise from a pronated foot are plantar fasciitis, bunions, and even knee, hip and lower back pain. When the foot pronates (rotates in), the lower leg and upper leg rotate in as well. This increases the strain to the knee, hip and lower back structures. 

Foot posture benefits when wearing orthotics

Foot posture and function abnormalities have been proposed as potential risk factors for low back pain, but this has not been thoroughly investigated. Low back pain is a very common problem all over the world, with a point prevalence of 18% of the general population. The financial cost of low back pain in terms of health-care costs and lost productivity is significant. According to several authors, people with low back pain are more likely to have planus (low-arched or pronated) feet. Foot pronation is rolling your foot inward to lessen the force during landing. Although it is a component of the body’s normal motion, it varies from person to person. Foot rolls inward when it makes contact with the ground to absorb the ground reaction force. Foot’s arch bears three times of body weight on average as a result of this.

Variations in foot position can affect pelvic alignment and the activity of the erector spine and gluteal muscles when walking, according to research. Variations in the height of the medial longitudinal arch have been shown to affect the magnitude of accelerations at the lumbar spine when running.

When the foot pronates during the early stance phase of gait, the calcaneus everts while the talus adducts and the plantar flexes. Increased unilateral foot pronation may result in lower limb biomechanical changes during gait. Excessive foot rotation, or pronation, can result in internal rotation of the tibia, which changes how the patella (kneecap) tracks and causes knee pain and PFPS (patellofemoral pain syndrome). In this situation, pain on the inside of the knee (medial) is common. Meanwhile, In theory, the increased internal rotation of the femur results in anterior pelvic tilt due to the sacroiliac joint’s tight fibrous connection. Although these movements are thought to be normal components of gait, it is possible that in individuals with ‘excessive’ foot pronation, Proximal joint compensatory movements increase in magnitude and place greater stresses on the lumbo-pelvic region, contributing to the development of low back pain.

Characteristics to consider when looking for an orthotic 

There are characteristics and considerations to look for in your orthotics. Have you been prescribed and dispensed with proper foot orthoses to meet your treatment goals? A properly fit orthotic should support your foot structure with the arch supporting and matching your foot. You should not be spilling over the orthotic on either side, and no ‘poking and pinching’ should be present. Orthotic features such as cushion and areas of support should be discussed and suitable to your diagnosis to offload and support key areas of need. 

In some cases, the weight of your custom orthotics can be a consideration. Different materials can be selected to reduce the weight, but considerations would be made to determine if heavier materials would be more suitable to reduce pain. 

One thing that you should not overlook is the cost of your custom orthotics. The average orthotic price is between $400-$650. If the cost is significantly lower, fact finding is recommended to ensure you are getting a good quality and truly custom device.

Over the counter inserts are a lower cost option to custom foot orthotics. Although it may not provide as much support as a custom insert, it can be a good alternative for some people. Talk to your Canadian Certified Pedorthist to see what options are best for you and your circumstances.

Improving foot posture by seeing a Pedorthist

After you and your Pedorthist have identified your particular problems, it’s time to act. Doing nothing will just allow your issues to get worse over time.

Aside from custom orthotics there are other modalities which may be recommended in your treatment. 

Firstly, your footwear is a very important piece of your treatment plan. The cost of shoes has nothing to do with how good they will be for you. You need to choose the shoe that has the right features for your particular condition. Those with issues should choose wisely.

Then there are off the shelf arch supports. These are devices manufactured on standard foot models and are by no means considered custom, so will not be looked after by your insurance. In some instances, depending on your issues they can work well at alleviating your discomfort. As always, it’s best to consult with a professional before you decide to treat yourself.

There are also various external shoe modifications that can be done to footwear to make them more appropriate for your feet. These include buttresses, lifts, and upper modifications. These modifications correct the biomechanical functioning of the feet and lower limbs, and in the case of upper modifications provide room for wayward toes. 

Taping, (a temporary solution), when done by a professional can help to get you through the acute phases of a foot injury. It can help with arch support, help brace the ankle, generally correct your foot posture quickly, for the short term. There are also rigid and soft splints for ankle support and control if long term support is required.

As always muscle conditioning helps the foot control itself. Stretching of muscles, tendons and ligaments can help to realign some joints, and allow them to function properly. 

Pronation, supination, orthotics, shoe modifications, footwear balance, how can you use all this information? What are “your” issues and “your” solutions? 

Don’t lose hope. All this information can be confusing, but not to your friendly Canadian Certified Pedorthist.

Education is part of our mandate so come and let us help you solve your problems.