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Orthotics for pronator?????

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 im off 05 Oct 2020

Hi.

So I've finally visited a podiatrist. I pronate on my left foot. No foot or ankle pain. I have medial knee pain with a diagnosis from a physio of chronic medial meniscus wear n tear. I wondered if stopping any pronation would stop any inward twisting of knee and protect my medial side of knee from pinching entrapment etc.

I've had these corrective insoles know a week and getting more pain. I wonder if the pronation may have been actually helping acting as a partial shock absorber. The insoles do stop my knee rotating in as I walk.

Anyway....rambling on....

Anyone been down this route? Maybe I need to give the insoles more time to get used too.

Another thought is....if you support your foot with insoles that support your arches, will your feet start to loose strength in supporting themselves.

Thanks peeps and sorry for being a bore rambling on about feet.

 SAF 05 Oct 2020
In reply to im off:

Have you introduced your new insoles gradually? If not this might explain the increased pain.

In reply to im off:

I've a different problem (metatarsalagia), physio said inner soles only partially solve the problem, better or more appropriate footwear and exercises are critical. Seems to have worked, but it's a slow game as the exercises improve things over months, not weeks. 

If in any doubt get a second opinion. 

In reply to im off:

I tried various insoles, corrective shoes etc for years for recurring knee and shin problems mostly from running. Eventually saw a running coach who was into the whole barefoot (or rather zero drop) scene. I was deeply sceptical but all the physio exercises he had me doing eventually worked and I don't have any issues running or hiking now. If I'm running a lot I'll do a day a week of exercises but generally don't have to bother.

My advice would be to try and find a decent sports physio that's interested in bio mechanics, as I suspect correcting one problem might create another (as maybe you're finding).

 henwardian 05 Oct 2020
In reply to im off:

I've been down this road. Knee pain caused by pronation. I got insoles and the pain went away. At the time you could get a variety of different insoles ranging from custom-super-awesome-expensive to out-the-packet-cheap-as-chips and I went for somewhere in the middle.

You should also have exercises to do, if not you should ask a physio. Assuming your podiatrist is any good the insoles you have been given should work, presumably the podiatrist watched you walking with them and said "that looks ok"? If they didn't they certainly should have. If they did then you should probably be trusting their expert opinion at this stage.

Also if you wear floppy garbage trainers a lot, get rid of them and start wearing something a little more solid.

Even if damage isn't permanent, it will take some time for the pain to go and the orthotics to have an effect, most likely months.

Post edited at 17:26
 im off 05 Oct 2020
In reply to henwardian:

Shes a physio and podiatrist. Watched me walk up n down. Yeah.....I maybe need go gradually get used go them and give time.

I suppose climbing is going to keep my arches exercised.

Thanks folks.

 GeorgeR 06 Oct 2020
In reply to im off:

I looked at getting orthotics a few years back for hip pain ( thought to be caused by pronation)that wouldn't go away even after many sessions with an oesteopath, got measured and everything but was trying to rationalise having multiple inserts for all different footware at £X ago. Anyway turned out the hip pain was caused by compensating for a knee that was knocking in as i walked all caused ultimately by an over tightness in my calf! A series of deep massages and stretches sorted it all out.

The moral of the story is that our bodies are very complex and try to fix the problem at the point of pain is not always the way to go.

I would suggest getting yourself properley straightened out with a combination of sports massage and some yoga type stretching.

 Big Lee 11 Oct 2020
In reply to im off:

Just to be clear, it's normal to pronate, and it's normal to have internal rotation of the leg in connection with this. It helps with shock-absorption as you say. Based on my experience, as an orthotist, and based on the literature I've read, you're not likely to change the position or movement in your knee significantly. You can usually impact the moment, or directional force running though the knee in order to try and offload it medially. The issue is though, to reduce the moment that loads the medial side of the knee you generally need to be wedging/building up the lateral side of the insole. Ie not under the arch or along the medial side of the foot. Building up the insole medially is going to potentially increase load in the knee medially. There's good evidence for what I'm saying. Google laterally wedged insoles together with medial osteoarthritis. You'll find lots in Google Scholar. I've obviously never met you, but so it's difficult to do anything but generalise, but if the insoles are making the knee worse maybe get a second opinion? I usually treat these sorts of knee pain with a special type of knee support anyway that that offloads the knee medially. The problem with insoles is that they cross the foot and ankle, which lessens the impact on the knee, since the foot and ankle will accommodate to the insoles to a degree. Hope that's some help anyway. Maybe find a private orthotist - I've never done any private work in the UK but I know this sort of thing is bread and butter for most. 

 Lyndleme 12 Oct 2020
In reply to im off:

Get well soon, hoping for your fastest recovery 

 im off 12 Oct 2020
In reply to Big Lee:

Thanks.

I've stopped wearing them. I cant see how they're right for me if they cause more pain. They do stop my knee twisting in at the end of a step but I think this is an important part of movement like u say. It was a long shot seeing if orthotics would help so no probs. Stopping running and cycling instead is helping alot. 

Dont know if I can be straightened up much. Right ankle has a talus bone that's rotated slightly into varus...lat collat tear years ago.

I'm in the....managing pain....category I think rather than any correction😂

 im off 12 Oct 2020
In reply to Lyndleme:

Thanks. 🙂


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