top of page

Foot Pronation and Flat Feet. Your TMJ, Neck, and Pelvic Floor Pain Can Start in Your Feet! Overpronation Causes Hip Compensation Leading to Jaw Pain. And Feet Pain Can Result From Pelvic Dysfunction

Updated: 4 days ago

A woman's healthy bare foot, outside, against a green garden, with a pink flower next to the big toe.
Healthy movement and strength in your feet is the foundation of freedom throughout your entire body. Pronation is a natural foot movement, but when you overpronate, your ankle, knee, and hip must compensate, leading to restrictions and pain.

Pronation and supination are natural foot movements in the gait cycle. The gait cycle is the series of movements that occur when walking. Your foot needs to come off the ground, and your foot needs to land on the ground, and the muscles from the foot to the hip are coordinating those motions. Those muscles are making instant compensations, shifting to keep you moving straight forward. The foot needs to pronate, but overpronation is a strategy of the brain, trying to find function in a dysfunctional system.


This post will focus on foot pronation and overpronation and mention supination.


Manual therapy recognizes the interconnectedness of the entire body. If your trapezius muscle hurts at the level of your shoulder, we know that is because of compensation, and we need to work with the neck, the ribcage, and the diaphragm; we need to create safe movement and safely restore strength. We would not inject the trapezius muscle with Botox because that creates instability. We would use knowledge and—more importantly—we would use a highly developed sense of touch to find the true cause of your pain and remedy your pain.


Being a TMJ pain, jaw pain, neck pain, and pelvic floor pain therapist, I work directly on those specific areas of the body. It is very hard to find concentrated therapy that creates soft tissue change in those areas. My in-office treatments focus on directly changing the tissue of the jaw, of the neck, of the pelvic floor, and the structures connected to those areas. I work on a lot of diaphragms, a lot of psoas and iliacus muscles, and give explanations of breathing. These muscles and their connections affect your TMJ, jaw, neck, and pelvic floor.


And here is the thing: so does the way you walk. As I will outline in a post HERE (COMING SOON!) your foot position absolutely affects the contraction of your abdominal and pelvic floor muscles.


I do not perform manual therapy on feet in the office; I directly work with the soft tissue and restrictions in and around the TMJ, jaw, neck, and pelvic floor. For pelvic floor pain, I work with the adductors, hip flexors, and other important structures. These foot, leg, and hip blog posts are to inform the women I see in my practice.


Keep reading for information on foot pronation!



This post is about the foot movement of pronation, but in a post I absolutely LOVE on dorsiflexion HERE (COMING SOON!) I outline the foot movement of dorsiflexion and all the many ways that dorsiflexion affects your entire body. A lack of ankle dorsiflexion is linked to overpronation.


Stay Tuned For In-Person Foot and Pelvic Floor Classes Coming The Year!


What this Post Includes:


  • Symptoms of Overpronation


  • YouTube Links


  • Lets Define Pronation, Overpronation, and its Opposite Motion, Supination


  • Technical Pronation Information


  • Flat Feet


  • Overpronation Causes - This is the main focus of this post and is fairly detailed

  • Some Symptoms of Overpronation in Detail

A woman who was out exercising, wearing hot pink shoes and shorts,  holding her knee in pain.
Too often, therapy is applied to the areas of pain and not the root cause. And often, an issue like knee pain will have two causes: a hip component and a foot component. The foot, being the body's base, can be the initial cause of hip compensation.

Symptoms of Overpronation

Further in this post, we will detail some of the pain and medical issues that overpronation causes.


Here is a quick list of symptoms:


  • Dynamic knee valgus


  • IT band syndrome


  • Plantar fasciitis


  • Low back pain


  • Inside ankle pain


  • flexor hallucis longus tendonitis


  • Piriformis syndrome


  • Inside and outside knee pain and arthritis


  • Low back pain


  • Outside ankle pain and subtalar joint issues


  • Achilles tendonitis


  • The big toe curves inwards. Bunions


  • Hammertoes 


  • Heel pain


  • Posterior tibial tendonitis


  • Shin splints


  • Tired feet


  • Metatarsalgia


  • TFL muscle pain


  • Leg cramping and pain


  • Bone spurs


  • Stress fractures

Quick plug for my two favorite supplements!

Healing inflammation begins in the gut! And liposomal vitamin C is great for fascia!


Use this link to head to their main website: https://bodybio.com/TLC


Use the code TLC at checkout and save 15%.


Click the pictures to head right to each product (but use TLC at checkout for the discount):


A bottle of sodium butyrate from BodyBio.
A bottle of BodyBio brand liposomal vitamin C
A pink banner graphic that says YouTube over and over again.

YouTube Links

You can head to a blog post that lists the muscles of the lower leg and also includes YouTube video links to aid your understanding of lower leg movements: HERE


You can head to a blog post that lists what muscles create hip movement and also has YouTube video links to aid your understanding of hip movement such as internal rotation: HERE


Here are my recommendations for YouTube videos that will visually aid you in understanding foot pronation and overpronation:


This video is focused on toe position and illustrates the movements of overpronation:


Overpronation and running:


As of this time, I have not watched this video...but I could in just a few seconds it would be helpful! This video explains overpronation and how to correct it. Based on its title, it is taking the stance that more needs to be done than to strengthen the lower foot muscles. That is true, but most people who overpronate have also never tried to strengthen the bottom of the foot muscles. Healing likely will take rehab of the foot and lower leg and hip.


This video repeats from another post but explains leg position as it relates to overpronation:



*There are two YouTube video links for "Paper Test or Concrete Foot Arch Test Directions," in that section below.




A graphic designed image showing feet in three different positions, Overporantion, neutral, and supination.
Pronation and supination are healthy movements of the foot. During the gait cycle, your foot moves into and out of these positions. It is when we get stuck in pronation and do the motion excessively that dysfunction begins. Pronation is a common compensation and is a strategy of the brain. The brain is trying to find movement in overpronation because there is either unwarranted motion or a lack of motion elsewhere. By carefully evaluating the health of your feet, and through conscious practice and therapy, you can heal excessive overpronation and lessen full-body compensations.

Lets Define Pronation, Overpronation, and its Opposite Motion, Supination

Pronation and supination are anatomical descriptions of body positioning and can describe the movement of your hand, arm, or foot. This post focuses on the movement of the foot.


Pronation is a natural movement of the foot and is essential in stabilizing you and propelling you forward in space during the gait cycle. It is important to know that because if someone hears about the problem of foot pronation, they will misunderstand the concept. You need foot pronation. What you do not want is overpronation.


Let’s Define:


Pronation

Pronation, also called neutral pronation, is the natural inward motion or roll of the foot. This means you are distributing weight more-so on the inside of your foot, the big toe side, or the medial edge.


Pronation subtly combines three motions. The motion of the medial edge of your foot leaning into the ground is called “foot eversion.” The three motions of foot pronation will be defined below, but really the most important thing to understand is that pronation can be observed by paying attention to foot eversion, the big toe side of your foot leaning into the ground (eversion is expalined again below).


Neutral pronation allows for shock absorption and balance. It allows your foot to adjust when you hit an uneven surface. In the gait cycle, when your foot very first hits the ground, it is in subtle supination (as defined below), but quickly moves into pronation. Pronation is a position of adaptability, and a healthy foot will be strong, soft, and mobile in this phase.


Overpronation

Overpronation is when your foot excessively rolls inward. This sounds like this would be a dramatic motion, but many people overpronate without realizing it, and like all other dysfunctions, this motion happens in various degrees. Overpronation causes poor shock absorption and places strain on the ankles, knees, and hips. It also creates a variety of compensations throughout the entire mind-body system. The shoe wear pattern of someone who overpronates, will be on the inside edge of the shoe’s sole.


As you will learn in my post on the foot motion of dorsiflexion (again HERE COMING SOON!), a lack of dorsiflexion can create overpronation. Overpronation creates a loss of arch and flat feet and flat feet are a cause of overpronation.


When you overpronate, the subtalar joint and the fibula are rubbing on the bone below. The heel will have a valgus alignment associated with a flat foot. You will learn more about foot overpronation below, including the link to flat feet.


Supination and Excess Supination

Supination is the opposite motion of pronation, and it is when your feet roll to the outward edge of your foot, the pinky side, or the lateral side. This movement raises the arch and turns the sole of the foot outward. Whereas supination subtly combines three motions, the act of the lateral edge of your foot leaning into the ground is called “foot inversion.”


Instead of your foot “spreading out,” as what happens with the loss of arch during overpronation, excess supination will create a rigid foot.


This is because during the mid-stance phase of the gait cycle, when your foot is fully on the ground, the foot naturally supinates and as it does, the mid foot “locks,” and it is this lock that creates a rigid platform for the body to push off from. This gives you force as you push off with your toe (during this toe-off stage your foot is still in a slightly supinated position).


But if through muscle imbalance and dysfunction you have developed a constantly supinated foot, a foot that does not move into pronation, a foot where the outside edge of your foot—your smaller toes—are taking on too much work, you will develop a chronically rigid foot. Flat feet, as defined below, can also appear inflexible. So notice your foot motions mixed with the ridged symptom.


People with high arches supinate. An excessively supinated foot will have a wear pattern on the outer edge of the foot, especially along the heel and ball of the foot, again on the pinky toe side of the shoe.


When you supinate, the medial aspect of the subtalar joint has a gap. The heel will have a varus alignment seen with a high arched foot.


Look for another post on supination HERE (COMING SOON).


This graphic designed images shows two foot movements: eversion and inversion.
If the technical info seems complex, ignore it! Otherwise: The foot doesn't just pronate and supinate. It moves in multiple directions, and the motions of pronation and supination are actually combinations of three motions. To heal your foot you can examine "large" causes, which will be defined below. A cause may be tendonitis in a shin muscle. But you might also do general foot, and ankle mobility and strength exercises and notice where you have "smaller," (and undefined to you) foot and ankle restrictions and foot and ankle strength. In my post that shows the muscles of the lower leg, I link to other people's foot and ankle videos.

Technical Pronation Information

Pronation is talked about as a single motion, but it is actually three-foot movements: eversion, dorsiflexion, and forefoot abduction.


Here are descriptions of the three-foot movements that create pronation:

  • Eversion is when the bottom lateral (midline) aspect of the foot, the midline or big toe side, presses into the ground. If you are just everting your foot, the pinky side would be up in the air.


  • Dorsiflexion is when your foot and shin come closer together. This happens if you raise your toes in the air toward your shin, but it also happens when you were to do a squat, moving your shin closer to your foot. And again, you can access a post about dorsiflexion HERE COMING SOON!


  • Forefoot abduction (you can also call this external rotation) is when your toes turn away from the midline of your body. In normal forefoot abduction, this motion is not that noticeable.


When you combine these three motions, you pronate your foot. If the dynamic foot and ankle are not performing these motions smoothly, or if they are under the force of structures above, you will not have healthy pronation.


My very general advice right here is not to worry about the three motions, but let this information encourage you to seek whole foot and ankle strength and mobility. You can watch videos on foot and ankle mobility and observe your blockages and the motions that cause them. You do not really need to be an expert in anything technical to free up your blocked foot and ankle motions; you just need exploration. And of course, you can seek professional guidance from those who understand and directly therapeutically work on all the areas mentioned.


This image shows three women in a park doing banded squats.
Dorsiflexion happens when you move your toes closer to your shin. Dorsiflexion also happens when you move into a squat. With a fixed foot, your shin is moving closer to your toes. Check out my dorsiflexion post to learn more!




This graphic designed image shows the foot in three ways. Foot prints of flat foot, normal foot, and hollow foot. It then shows what the foot would like from the side view, the full foot and what the arch looks like that matches those foot prints. The it shows what the ankle look like of each of those arch types.
This is a great graphic that brings a lot of this information together. Over time, overpronation creates flat foot, fallen arches. And fallen arches lead to flat feet. Below I link to a YouTube video that shows how you can do a paper arch test at home.

Flat Feet

Flat feet, or flatfoot, is a condition where you have a loss of arch on the bottom of your foot. You need a healthy arch to enhance mobility, absorb shock, and transfer weight to the ankle joint effectively. A healthy arch allows for healthy tibia and fibia (lower leg bones) movement, which aids in femur movement, which aids knee health, and hip motion. Flat feet can cause overpronation, and flat feet can be created by overpronation. Flat feet can be genetic; you can be born with flat or flatter feet than ideal, or you can develop flat feet.


If you believe you have flat feet, you can do an at-home paper test/concrete test or head to your local running store and have them analyze your arch (many of them have helpful machines that can do this). You can also see a bodywork professional that you know does this.


Flat feet can have a flex to them. You may have some arch when the foot is off the ground, you can see and feel an arch, but that arch may disappear when you stand on the foot. In that case, your foot may feel soft.


If your foot has no arch when standing and your foot remains that way when lifted off the ground, you most likely have a foot that feels hard. Either way, you need to focus on strengthening the arch.


Flat feet (or flatter feet than ideal feet) are a problem when your arch supporting muscles are not working. That is the difference between functioning genetically flat feet and feet that have been stretched to far.


Paper Test or Concrete Foot Arch Test YouTube Link Directions:




Overpronation Causes


A Lack of Supination

A lack of supination creates overpronation. If your foot and ankle lack the ability to perform the motions of supination, your brain will compensate and find the path of least resistance to get your foot on the ground. One motion of supination is inversion—the lateral edge of the foot leaning into the ground. This movement primarily occurs at the subtalar and transverse tarsal joints within the foot. The tibialis posterior muscle, which supports the medial longitudinal arch of the foot, is a plantar flexor and a foot inverter. The tibialis anterior muscle is a foot dorsiflexor and a foot inverter. If these muscles experience stress and inflammation, your body may avoid the motion of supination and lean towards the motion of pronation.


The muscles that supinate the foot need to be strong and healthy. These muscles are: tibialis anterior, peroneus longus, peroneus brevis, extensor digitorum longus, extensor hallucis longus.



A graphic designed image of the lower leg, showcasing the tibialis anterior.
You can research the muscles of the lower leg. My lower leg post is not super exciting, but if you glance at it, you will see all the muscles outlined in one spot. Access it HERE

Weakness or Inflammation of the Tiblias Anterior Muscle

The tibilas anterior muscle is a primary driver of supination and inversion. It activates to supinate, but that also means it activates to prevent overpronation. An inflamed tendon will struggle to prevent overpronation.


A graphic designed image of the lower leg and showcasing the tibialis posterior muscle.

Excessive Pronation and Hypertonic Muscles

The tibialis posterior muscle stabilizes the arch during pronation and is one of the main direct muscles that facilitate foot pronation. If your tibialis posterior is tense and pulling, it will promote excess pronation.


Primary Arch Muscles/Calves

The peroneus longus and the tibialis anterior muscles form a sling under the foot that supports the foots arch. Other muscles also support the foots arch, but these two muscles are important for forming that sling, also referred to as a “stirrup.”


Together, the peroneus longus and tibialis anterior form a stirrup, but are also antagonists to one another. Peroneus longus everts the foot; tibialis anterior inverts the foot. Peroneus longus plantar flexes the foot, and tibialis anterior is the foots strongest dorsiflexor.


These muscles contract together to squeeze and support the bones of the foot. These muscles need to be healthy in order to perform their individual actions and to work together to stabilize the ankle and foot and form a supportive arch that the rest of the body relies upon.


Here is a fabulous study that describes how these muscles work together to support the foot’s arch: https://pmc.ncbi.nlm.nih.gov/articles/PMC9776458/



A photo with a graphic designed image of the foot bones. The bones are shown in red. The photo is of a runner about to take off in a track event. The bottom of the foot in the start position.
I could not find an accessible graphic that shows the muscles on the bottom of the foot ;) But imagine the bottom foot bones covered in four layers of little muscles that need to be flexible and strong. If these muscles are not flexible, they could not be move into an effective push-off stance, as shown in this photo. If the muscles are not strong, the foot will loose it shape and will not have the stability or strength needed to effectively push-off. Without these muscles holding their shape, other structures will take on too much load. Once overloaded, these other muscles, tendons, and fascia will acquire micro-tears and inflammation.


Intrinsic Plantar Muscles

Four layers arrange the muscles on the plantar (bottom) of the foot. All intrinsic plantar muscles are entirely on the foot; they do not originate or insert onto the lower leg. They move the toes, stabilizing and fine motor control, and supporting the foots arch. Think of these muscles as the foots “deep core.”

My favorite thing about these muscles is their relationship to your brain. These muscles are rich in sensory fibers and instantly communicate with various parts of the brain. The intrinsic muscles are relaying textures, gradient slopes, temperatures, pressures, and spatial awareness. These muscles tell the brain about the need for balance, weight shifting, and subtle and gross movement, and then these muscles are the foundational framework for the body's physical response to that need.


A quick side note: the bottoms of the feet light up many areas of the brain, and the brain increases activity in areas such as emotional regulation and cognitive processing. There are studies that show that therapeutically working on the bottom of the feet, reflexology, aids in mind-body fatigue, sleep, and pain.


In the gait cycle, these muscles help the toes touch the ground. If these muscles are weak, someone might compensate by gripping the ground with their toes. Weak muscles on the bottom of the foot will affect the arch and plantar fascia. When the arch is healthy, there is less strain on the ligaments and tendons above, and the brain does not need to recruit larger muscles to fill this role.


Here are the four levels of the foots intrinsic muscles:


  • First Layer: abductor hallucis, flexor digitorum brevis, and abductor digiti minimi


  • Second Layer: quadratus plantae and the lumbricals


  • Third Layer: flexor hallucis brevis, adductor hallucis, and flexor digiti minimi brevis


  • Fourth Layer: dorsal and plantar interossei



A graphic designed image of the pelvis with the obturator externus muscle.
This image shows the obturator externs muscle, which is one of the six lateral (and external) rotators of the hip. The other muscles are listed below.

Hip Muscles

The muscles of the hip—muscles that move the femur—will affect your feet because the movement of the femur affects the knee and lower leg. The knee and lower leg affect the feet. Fascia also connects your hips and legs. Some muscles of the pelvis and hip attach to the lower leg. Other muscles start on the thigh (the femur) and attach to the lower leg. Where the pelvis is in space, and how the hip is functioning and how the femur is moving, affect these muscles’ position and function, and this all affects the feet.


One could describe the lower leg as attached to the foot, or one could describe it as continuous with the foot. The tibia and fibia bones of the lower leg are jointed to the bones of the foot, and they affect the way the foot bones and foot muscles move and function.

The muscles of the hip stabilize the pelvis, and if the mind knows that the pelvis is not stable, compensations begin. Compensations based on the need for stability travel all the way to the feet. Another way the feet compensate for the hip is that if the femur is excessively rotating, the tibia will rotate, and the brain will change the position of the foot in order to get the body back to walking in a straight line.


That also works in reverse—a need of the foot or dysfunction of the foot can travel up to the hip. I will quickly explain this in anatomical terms, but don’t worry if you do not know these names; you will get the general idea.


In a weight-bearing foot that is pronating, the subtalar joint of the foot is not fully free to move. That joint is under pressure, under a load of weight. The talus bone and the tibia will medially rotate to create pronation. The knee itself does not have direct rotational mobility, but the femur twists and rotates medially as directed by the tibia. If the medial rotation of the femur needs to be countered and controlled by muscles of the hip. But if the muscles that laterally rotate (the opposite of medially rotate) the hip are not strong and turned on and working, the femur will medially rotate too far.


And here you can see how a cycle can begin. Either the femur being too medially rotated because of a lack of strong hip lateral rotators, or the foot being overly pronated, affecting the tibia, and therefore affecting the femur. And that lack of lateral rotator strength allows these conditions to happen chronically. This results in overpronation and a flat foot.


As an added note, when the smaller muscles of the hip are not functioning properly, the piriformis will fire and pick up that additional load.


You may need to strengthen your lateral rotator muscles to heal muiltple layers of dysfunction.


Hip lateral rotators are:


  • Piriformis: Located posteriorly, it helps in lateral rotation and abduction of the thigh


  • Gemellus Superior: Assists in lateral rotation and is above the obturator internus


  • Obturator Internus: Plays a key role in lateral rotation and is between the gemelli muscles


  • Gemellus Inferior: Found below the obturator internus, it aids in lateral rotation


  • Obturator Externus: on the outer side of the pelvis, it also contributes to lateral rotation


  • Quadratus Femoris: Positioned below the gemelli, it assists in lateral rotation and adduction of the thigh



This is a graphic designed image showing how the body compensates for a tilted pelvis. It shows how a tilt affects the shoulders and the leg.

Leg length difference is almost always functional. This means that you were not born this way. Rather your pelvis is under neuromuscular stress pulling one side of your pelvis down.



“Leg Length Discrepancy”

Someone can be born with a leg that is shorter than the other. But most people who are told they need to wear a shoe lift because one leg is presenting as longer than the other are getting some poor advice! I recently read a study that said that leg length discrepancy is “common,” but it did not discern between true leg length difference and functional leg length difference.


Muscle imbalances and learned nervous system patterning can cause your pelvis to tilt laterally, making one leg appear longer than the other. That is actually a pretty common pattern. Overpronation can occur on the leg that presents shorter, and here again, it will be working holistically with muscles further up the chain, healing the pelvis, that will aid in recovering from foot overpronation.



A Lack of Pelvis Internal Rotation

If your pelvis cannot rotate internally, it will cause the femur and lower leg to rotate internally to keep you moving straight forward. This creates dysfunction in the lower leg and causes muscles to work harder to stabilize the structures. This forced internal rotation can lead to overpronation.



Posterior Tibial Tendonitis

We have talked about the tibialis anterior muscle—on the front of the leg — and here we will mention the tibilas posterior muscle — on the back side of the leg.


Dysfunction followed by inflammation of the tibialis posterior muscle tendon creates a chronic condition called tibial posterior tendonitis. Chronic tendonitis causes a breakdown of the tendon which supports the arch of the foot and assists your foot in flexing. You will feel pain along the arch of your foot and/or the inside (medial) ankle. This condition begins as mild and progresses to difficulty in raising the heel.


Your toes may “splay” as you lose your arch, and your foot will become both flat and rigid. Ankle bones shift, and you can develop arthritis. Since this condition creates a weakness in the arch, it causes overpronation.



Tibial Rotation

Your tibia can excessively rotates inwards. Like all conditions, this happens in degrees. There is a condition called “internal tibia torsion” in which the tibia rotates inwards greater than 10 degrees. In that condition, it is my understanding that the foot would also follow along and rotate inwards. This condition is mainly present in children under the age of four.


But tibia internal rotation of a lesser degree is accompanied by foot pronation, which has an externally rotated component. This is because the brain wants you to walk straight. And so if your lower leg is internally rotating, your foot will shift. The foot will shift to create balance and keep you stable, and the foot will also shift because the brain is going to straighten out your walk. The brain wants your feet to move with your eyes, straight forward. So if the tibia internally rotates, the foot will pronate, and the foot will then be externally rotated.


And everything mixes. You could have feet that are flatter by birth, and you can subtly pronate, and then your tibia can lose external rotation and get stuck in internal rotation, and this can cause more pronation that leads to an even flatter arch. This is not to fear! Everything is in a cycle; this is just such a good example. Healing is still the same: creating muscle balance. But when you recognize that there are several areas to focus some energy on, healing will ultimately be faster and more complete.



This is a graphic designed image of the foot and ankle showing all the many ligaments of the ankle.
People who are hypermobile need to proactively and intentionally and gently create strength in their tendons and muscles. This helps support ligaments and keeps them from further stretching out. A lot of people do not know they are hyper mobile. If you have a lot of pain in various places in your body, you may want to explore if this applies to you.


Knee and Ankle Joint Laxity

There was a study that linked joint instability and pronation, and tibia rotation. This study found that in a population of women who showed known signs of laxity, there was an average increase in tibia rotation during knee flexion of 5 degrees.


Those with laxity in their ligaments know that extra attention is necessary for creating stability and finding a safe “container” of movement and strength. And laxity will affect some joints more than others. If someone has a myofascial disorder and naturally has looseness in their soft tissue structures, pronation can happen at the foot because of ligament, tendon, and/or plantar fascia laxity. Laxity in the hip, knee, and/or ankle and foot causes pronation.



This is a photo of the back of someone's calves. They are pressing into their toes and flexing their claves. The gastrocnemius muscle is visible.


Strong and Subtle Calves

When the gastrocnemius and soleus are tight, the ankle will lack a range of motion. The foot will compensate by overpronating.



Overpronation Symptoms


This is a graphic designed image of the knee bending towards the midline. The graphic has a title called Mechanism of ACL Injury. It also has labels for knee valgus, ankle eversion, knee abduction, and femur adduction. It shows how this comes together to create a knee having a ACL injury.
An impact injury can damage the ACL. You can imagine a soccer player being in the exact position that this photo shows. Hitting them on the side would force the knee further inward and snap the ACL. But this photo represents all the motions that happen on a smaller level every day as someone walks with an overpronated foot.


Dynamic Valgus - Overpronation Causes the Knee(s) to "Cave In"

Valgus is a condition where the knee is leaning medial, towards the midline. This causes pain on the inside of the knee. There are two types of knee valgus: the first type that someone is born with, and it will be visible at a young age. The second type of knee valgus is called dynamic knee valgus. In this type, you develop the pattern when you move and exercise while under the influence of foot and/or hip dysfunction followed by excessive tibia internal rotation.


Now, this next thing I am about to say would really be better for its own blog post on knee valgus, but for now, I will drop a little more information right here. In a study HERE it is pointed out that knee valgus during dynamic movements isn’t necessarily a bad thing. And this information fits a better model of care. We have individual bodies, and not all of our mind-body movement strategies are “bad.” When landing from a jump, the ground impact may cause the pelvis to tilt anteriorly tilt which will cause some medial knee movement. This might not be causing pain or any larger problems. If you look at a professional heavyweight lifter, their knees move medial when they push up, and this is because the body uses this motion to access more power.


More women experience issues with knee valgus than men do. And I would propose here that knee valgus is a problem not when it is part of a functional strategy, but when it is a habit that developed out of a lack of understanding, when a woman has a pain in her feet, hips, knees, or low back, when someone has laxity in their ligaments, and when it happens during daily movement.


The tibia can excessively rotate, and a pattern of knee valgus will develop. And whereas tibia rotation promotes overpronation of the foot, overpronation of the foot will create tibia dysfunction.


A valgus knee can cause:


  • Anterior cruciate ligament tears


  • Meniscus tears


  • Patellofemoral dysfunction and pain


  • Lateral compartment arthritis


  • Overall arthritis


  • Pain on the inside of the knee



IT Band Syndrome

The TFL and the glute muscles influence the it band and is a stabilizer for the hip and knee. Excessive internal rotation of the hip, knee (tibia), and foot is resisted by the IT band. The mechanics of the IT band will affect the foot, and the mechanics of the foot will affect the IT band.


Overpronation creates an internal rotation of the knee, which will then overwork and stress the IT band. The stressed IT band will create friction in the structures that surround it and attach to it, and inflammation results. Knee pain at the IT band attachment site is common.


The posterior tibial tendon supports the arch and counteracts overpronation. Chronic tension in the IT band, tension that keeps it unable to resist excessive internal rotation, is affecting the foot and straining the posterior tibial tendon. When the posterior tibial tendon experiences stress, the foot will probably overpronate and develop a flat arch.


Overpronation can happen for a main reason but is usually a result of multiple reasons. IT band syndrome can be a symptom of overpronation, and it can make overpronation worse, and then IT band syndrome pain will increase further.


When the plantar fascia hurts, the advice you normally hear is to stretch it out. And whereas I agree stretching it can feel good, the plantar fascia often experiences excessive stretching. Better advice is to notice where you are tight, especially in the calf muscles, and notice where you are weak. Calves can be tight and weak. To heal plantar fascia, you need to rehab your small foot muscles and your larger calf muscles.
When the plantar fascia hurts, the advice you normally hear is to stretch it out. And whereas I agree stretching it can feel good, the plantar fascia often experiences excessive stretching. Better advice is to notice where you are tight, especially in the calf muscles, and notice where you are weak. Calves can be tight and weak. To heal plantar fascia, you need to rehab your small foot muscles and your larger calf muscles.


Plantar Fasciitis

The fascia will lose its shape as the foot flattens out. And again, this can be because of stress on the posterior tibialis muscle. Underweight, the posterior tibialis muscle functions by contracting eccentrically and reducing tension on the foots fascia. When the muscle is weak, the fascia will experience increased tensile forces. This breaks down the fibers of the tendon.


Also, the plantar fascia tenses during the movements of the foot. Under the influence of a healthy gait, the tension on the fascia regulates the movement of the talus (the talus is the bone that connects the leg to the foot). Overpronation and excessive supination both increase plantar fascia tension. Since the plantar fascia originates at the heel, people often feel pain there during a disrupted gait.


Normally, I just place all the sources under the post, but here are two studies to reference:


Dubin A. Gait: the role of the ankle and foot in walking. Med Clin North Am. 2014;98(2):205-211. doi:10.1016/j.mcna.2013.10.002


Donatelli R. Abnormal biomechanics of the foot and ankle. Journal of Orthopaedic & Sports Physical Therapy. 1987 Jul;9(1):11-6.



A graphic designed image, a close up of a woman's low back with a red circle indicating low back pain.
There are many conditions that create low back pain and combine to create low back pain. Probably the most idiotic study I have ever heard of was one that pouted out that medication does not heal low back pain. That did not need to be studied. Yes, conventional medicine only has that to offer. That is because "regular" medicine has never been apart of the physical medicine conversation. Tylenol and ibuprofen will not heal your low back pain. Learning about your physical body and its needs will.


Low Back Pain

There is a link between low back pain, overpronation, and a loss of the longitudinal arch (flat feet).



A graphic designed image of the lower leg highlighting the flexor hallicus longus muscle.


Inside Ankle Pain

The flexor hallucis longus tendonitis runs on the inside of the ankle. The inward roll of the ankle creates strain on this tendon. This pain can run behind the medial malleolus and onto the arch of the foot.


In an overpronated foot, the subtalar joint collapses towards the calcaneus and the fibula also collapses towards the calcaneus. This causes arthritis and bone spurs.



Outside ankle pain Subtalar joint

A supinated foot, the subtalar joint gaps on the inside edge of the foot. This leads to a loss of the subtalar joint space on the lateral foot.


This is a graphic designed image of the pelvis highlighting the piriformis muscle. The image is showing how the muscle will compress thew sciatic nerve.

Piriformis Syndrome

When the foot chronically moves in overpronation, the knee can lean towards the midline. The piriformis has its attachments on the greater trochanter of the femur and stabilizes the hip and the pelvis. This important stabilizer muscle can become overworked and inflamed and compress the sciatic nerve.


Outside Knee Pain and Arthritis

When you overpronate and the knee collapses in towards the midline, the medial knee will experience a stretch of the ligaments and tendons, while the outside of the knee has the joint space being compressed. Eventually, this causes a loss of tissue and arthritis.



Bunions and Hammertoes

Overpronation causes the big toe to move closer to the other toes, leading to bunions and hammertoes to occur over time.




Check back for more articles on anatomy and your nervous system!



Check out my healing journals and books below!



And sign up for the mailing list!






Want to Know More?


I have more posts coming soon,. Stay tuned!


Check out my books on health and wellness!




This is the cover to The Elemental Woman book. A book on Ayurveda focused on women's health.

The Elemental Woman

A Conversation for the Modern Western Woman Inspired by the Healing Wisdom of the Ancient Eastern Sage




This shows the cover of Food & Mood Journal. A mindfulness journal for women's health to connect emotions and food.


Food & Mood Journal

 A tracking guide to connect the food you eat, the emotions you feel, and increase the feeling of deep self-love





This imagine show the cover of the Mindful Movement Journal. A mindfulness journal for women's health that connects emotions and movement and fitness.


Mindful Movement Journal

 A tracking guide to connect the motions you make, the emotions you feel, and increase the feeling of deep self-love






This image shows the cover of Basic Ayurveda. This is a hard cover women's health book that is a colorful refine guide to the main The Elemental Woman book. The Elemental Woman is a women's health book.

Basic Ayurveda 

The Elemental Woman Supplement Guide







About the author:

Since 2004, Tara Lee Clasen has been assisting women on their healing adventures. As a woman-focused physical medicine provider, also trained in Eastern medicine, she knows transformation is possible and knows that with reflection and self-love, your future is full of bright possibilities.







Resources














Ford, S.E.; Scannell, B.P. Pediatric Flatfoot. Foot Ankle Clin. 2017, 22, 643–656. [Google Scholar] [CrossRef] [PubMed]




































Dubin A. Gait: the role of the ankle and foot in walking. Med Clin North Am. 2014;98(2):205-211. doi:10.1016/j.mcna.2013.10.002



Chandler TJ, Kibler WB. A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Med. 1993;15(5):344-352. doi:10.2165/00007256-199315050-00006




Study on glut max for future post:



Hewett TE, , Myer GD, , Ford KR, , et al.. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med.2005; 33: 492– 501. https://doi.org/10.1177/0363546504269591



Beckerman LP. and Application of complex systems science to systems engineering. Systems Eng. 2000; 3: 96– 102. https://doi.org/10.1002/1520-6858(2000)3:2<96::AID-SYS4>3.0.CO;2-7


"In a prospective study of 710 athletes, there was a poor association between vertical drop jump and anterior cruciate ligament injury risk.8One reason the vertical drop jump continues to be advocated as a screening test, despite limited evidence, may be that dynamic knee valgus has traditionally been examined through a reductionist lens, that is, understanding the nature of a complex thing by reducing it to the interactions of its parts or to simpler, more fundamental things.1"





Best article on foot anatomy:

Comments


bottom of page