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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Hyperpronation of the Foot



- Discussion:
    - hyperpronation refers to the inward rotation of the foot during gait;
    - the term is vague and probably should be replaced by precise descriptions of the relative positions of the hindfoot and forefoot during gait;
    - w/ hyper-pronation, there is an inability of the foot to supination during mid to terminal stance phase;
    - diff dx:
           - hindfoot valgus causes the talar head to move in a medial and plantar direction (in children w/ CP the talar head can touch the 
                  floor);
          - to compensate the mid-foot (talo-navicular joint) must actually supinate (spin laterally and superiorly) which leaves the talar head 
                  uncovered;
    - hyperpronation does place stress on the midfoot, but does not become a significant problem unless the patient develops a heel cord 
          contracture;
          - w/ heel cord contracture, the already stressed midfoot must now compensate for loss of dorsiflexion at the ankle joint;
          - the result is a midfoot break, either at the talo-navicular joint or the navicular-cuneiform joint which leads to chronic pain;
    - is associated w/ flat feet as well as both tibia vara (? and genu valgum);


- Exam:
    - patient is viewed from behind and relative ankle-subtalar valgus is noted;
         - patient is asked to rise up onto toes and amount of inversion is noted;
    - ankle motion is noted (w/ knee extended and hindfoot in varus);
         - this is compared to dorsiflexion of the opposite ankle;
    - amount of talar head coverage and uncoverage is noted;


- Treatment:
    - its essential to determine the cause of the hyperpronation deformity;
    - equinus contracture:
          - patients w/ flat feet often have a more horizontal sub talar axis which allows a relative increase in sub-talar dorsiflexion and 
                 plantarflexion;
                 - this may result in relative decrease in ankle dorsiflexion;
          - in the presence of a relative heel cord contracture, the patient should be started on a diligent course of stretching;
          - this will take the stress off the midfoot, and in most cases will relieve pain;
    - leg length descrepancy:
          - may cause a relative equinus contracture and hyperpronation of the foot;
          - treated w/ heel lift on contra-lateral side;
    - foot orthotics:
          - are generally very expensive and and in many cases ineffective;
          - generally orthotics should not be prescribed until the heel cord contracture is corrected;
          - note that after paying several hundred dollars for a pair of orthotics many patients will be embarased to admit that the orthotics don't work



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 30, 2011 12:33 pm