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The foot and ankle form a complex system that supports body weight, provides balance, absorbs shock, and transfers ground reaction forces. Pronation is a natural movement of the foot that occurs during walking or running. It is the side-to-side movement of the foot that results from the transfer of weight from the heel to the ball of the foot. Pronation can be normal or abnormal, with abnormal pronation occurring when the foot pronates when it should supinate, or overpronates during a normal pronation period. Overpronation is a common issue that can lead to injuries and is usually associated with many overuse injuries in running. One of the key muscles that supports pronation is the Tibialis Posterior, which works alongside the calf muscles to control pronation as we propel ourselves forward.
| Characteristics | Values |
|---|---|
| Definition | Pronation is a natural movement of the foot that occurs during foot landing while walking or running. |
| Components | Subtalar eversion, ankle dorsiflexion, and forefoot abduction. |
| Gait Cycle | Pronation is the first half of the stance phase, whereas supination starts the propulsive phase as the heel begins to lift off the ground. |
| Normal Pronation | In normal pronation, the weight distributes evenly throughout the foot. |
| Abnormal Pronation | Abnormal pronation occurs when a foot pronates when it should supinate, or overpronates during a normal pronation period of the gait cycle. |
| Overpronation | Overpronation is when the arch of the foot collapses excessively downward or inward. It can lead to flat feet and increase the risk of injuries. |
| Underpronation | Also known as supination, underpronation is when the foot rolls outward. |
| Muscles Involved | The Tibialis Posterior muscle plays a key role in supporting pronation, along with the calf muscles. |
| Treatment for Overpronation | Orthotic insoles, supportive shoes, physical therapy, and strengthening exercises for lower leg muscles. |
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What You'll Learn
Tibialis Posterior
The tibialis posterior is the deepest and most central muscle in the posterior compartment of the leg. It is located posterior to the tibia, fibula, and interosseous membrane of the leg. The latter separates the tibialis posterior from the anterior leg muscles. The belly of the muscle is overlapped by the flexor hallucis longus and flexor digitorum longus muscles. The tibialis posterior is also hidden from view by the large, superficial muscles of the leg, which include the gastrocnemius and soleus.
The tibialis posterior is a key stabilising muscle supporting the medial arch of the foot. It also plays an important role in stabilising the medial longitudinal arch. Tibialis posterior dysfunction can lead to flat feet and weak arch control in adults. Tibialis posterior tendon dysfunction (TPTD) is thought to be the likely cause in most cases of adult-acquired flatfoot.
The tibialis posterior is attached between the bones of the leg and the foot. The muscle consists of two parts close to its origin: medial and lateral. The medial portion arises from the upper two-thirds of the posterior surface of the tibia, inferior to the soleal line, and from the posterior surface of the interosseous membrane of the leg. The lateral part originates from the upper two-thirds of the posterior surface of the fibula. The two parts become one muscle, which travels towards the foot. At the ankle, the tendon of the tibialis posterior passes posteriorly to the medial malleolus of the tibia.
The tibialis posterior is also related to some important neurovascular structures. For example, it lies anterior to the posterior tibial artery, which gives off a branch called the fibular artery. The fibular artery descends between the fibula and tibialis posterior. The anterior tibial artery travels between the medial and lateral parts of the muscle, close to its origin points. The tibial nerve travels over the tibialis posterior for most of its course.
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Calf muscles
The calf muscle is located in the back of the lower leg, starting below the knee and extending to the ankle. It is responsible for various functions, including walking, running, jumping, and flexing the foot. The calf muscle is composed of two main muscles: the gastrocnemius and the soleus. These muscles come together above the heel and attach to the Achilles tendon. The gastrocnemius is the larger and more superficial of the two, located just under the skin at the back of the lower leg. The soleus is deeper and helps to stabilize the ankle.
The gastrocnemius and soleus muscles work together to enable movement and support the body's weight. They are both skeletal muscles, composed of many individual fibres that create a striped appearance when bundled together. The calf muscle also includes a third, smaller muscle called the plantaris, which is absent in about 10% of the population. The plantaris muscle forms a tendon that runs between the gastrocnemius and soleus, blending with the calcaneal tendon.
The tibial nerve innervates the muscles of the calf, providing sensory and motor functions. The sural nerve is a branch of the tibial nerve that specifically innervates the calf muscle. The venous system of the calf includes both superficial and deep veins. The superficial veins are the greater and small saphenous veins, while the deep veins include the popliteal, anterior tibial, posterior tibial, and fibular veins.
The calf muscle is susceptible to various conditions and injuries. Muscle strain is the most common injury, occurring when the muscle fibres are stretched too far or tear due to strenuous exercise or overuse. Leg cramps are also prevalent in the calf muscle and can be caused by factors such as dehydration, pregnancy, or certain medications. Calf muscle injuries often require rest and recovery, with relatively short recovery times compared to other muscle groups.
To strengthen the calf muscles, exercises such as standing calf raises, donkey calf raises, and stair calves are effective. These exercises can be modified by keeping the knee straight or bent to target the gastrocnemius or soleus muscle, respectively. Ensuring a pause at the top and bottom of the movement emphasizes the muscle and reduces the stress on the Achilles tendon.
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Gastrocnemius and soleus muscles
The calf muscle is made up of two main muscles: the gastrocnemius and the soleus. These two muscles come together above the heel and form the Achilles tendon. The gastrocnemius is placed just under the skin at the back of the lower leg, and it forms the bulk of the calf muscle. The top part of the gastrocnemius has two heads that start on the inside and outside of the thighbone (femur) and go down the back of the leg, attaching to the Achilles tendon. The soleus sits slightly deeper than the gastrocnemius and is wide and flat. The two muscles are sometimes referred to as one large muscle with two sections.
The calf muscle supports the body when standing and enables movement of the foot and lower leg. It propels the body forward when walking or running and allows jumping, ankle rotation, foot flexion, and knee locking. The gastrocnemius and soleus muscles also help to maintain good posture.
The gastrocnemius and soleus muscles are involved in pronation and supination, which are terms used to describe the up or down orientation of the foot and the mechanics of how one stands, walks, and runs. Pronation is a natural movement of the foot that occurs during foot landing while running or walking. It is composed of three cardinal plane components: subtalar eversion, ankle dorsiflexion, and forefoot abduction. These three distinct motions occur simultaneously during the pronation phase. Pronation is a normal, necessary, and desirable component of the gait cycle.
Abnormal pronation occurs when the foot pronates when it should supinate, or when it overpronates during a normal pronation period of the gait cycle. Overpronation happens when the arches of the feet flatten more than they should, causing the foot to roll inward. This puts strain on the muscles, tendons, and ligaments that support the arches and increases the risk of injury to the foot and leg. Underpronation, also known as supination, is when the foot rolls outward when walking.
Pronation can be influenced by muscular weakness or tightness in the gastrocnemius and soleus muscles. To prevent and correct abnormal pronation, orthotic insoles can be added to shoes, and exercises can be performed.
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Tibialis Anterior
The tibialis anterior is a muscle in the anterior or front part of the leg. It is situated on the lateral side of the tibia, and its fibres run vertically downward, ending in a tendon at the lower third of the leg. This muscle is easily palpable and is the most medial muscle in the anterior compartment of the leg. It overlaps the anterior tibial vessels and deep peroneal nerve in the upper part of the leg.
The tibialis anterior is the primary dorsiflexor of the ankle and plays an important role in the activities of walking, hiking, and kicking a ball. It stabilises the ankle as the foot hits the ground and helps to maintain the medial arch of the foot. It also functions to 'lock' the ankle, as in toe-kicking a ball. The tibialis anterior aids in any activity that requires moving the leg or keeping the leg vertical.
The tibialis anterior is one of the muscles that tend to be inhibited and underactive, which can lead to abnormality in the anticipatory postural adjustment (APA) phase during gait initiation of the affected limb. People with an inhibited or weak tibialis anterior, such as those with hemiplegia or Parkinson's, will experience this abnormality. They may try to compensate for the weakness of the tibialis anterior by overactivity of the contralateral tensor fascia latae (TFL).
Pain along the path of this muscle is often referred to as "shin splints" or medial tibial stress syndrome (MTSS). Excessive physical activity, especially among runners and military personnel, can result in repetitive microtrauma of the tibialis anterior, causing pain along the anterior edge of the tibia. This generally resolves with rest, but nonsteroidal anti-inflammatory drugs (NSAIDs) and ice can also be used as treatment.
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Ligaments
Pronation is a natural movement of the foot that occurs during walking or running. It is composed of three cardinal plane components: subtalar eversion, ankle dorsiflexion, and forefoot abduction. These three distinct motions occur simultaneously during the pronation phase. Pronation is a necessary component of the gait cycle.
During overpronation, the foot rolls inward, causing the arches of the feet to flatten more than normal. This puts strain on the muscles, tendons, and ligaments that support the arches. Overpronation increases the risk of injuries to the foot and leg. It can be corrected with exercises and orthotic insoles.
Some of the main foot ligaments include:
- Plantar calcaneonavicular ligament (spring ligament)
- Calcaneocuboid ligament
- Lisfranc ligaments
Ligament injuries can be painful and slow to heal. They can be caused by sports that involve quick twisting motions, such as basketball, soccer, football, or dancing. Conditions that may affect the foot ligaments include plantar fasciitis, foot ligament sprain, and Lisfranc injury.
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Frequently asked questions
Pronation is a natural movement of the foot that occurs during foot landing while walking or running. It is composed of three cardinal plane components: subtalar eversion, ankle dorsiflexion, and forefoot abduction. These three distinct motions occur simultaneously during the pronation phase.
Overpronation is when the arch of the foot collapses excessively downward or inward. It is associated with flat feet and can lead to injuries. Overpronation can be caused by various factors, including obesity, running or walking on hard surfaces for extended periods, and structural issues in the foot.
The key muscle that supports pronation is the Tibialis Posterior. This muscle controls the movements of the ankle during pronation, working eccentrically to flex and turn out the ankle. Additionally, the calf muscles and Tibialis Anterior and Posterior muscles also play a role in pronation and raising the medial border of the arch.
Overpronation can be corrected through physical therapy, orthotic insoles, and wearing well-fitting, supportive shoes. Orthotic inserts help support the arches and prevent overpronation. Individuals who run or walk frequently should also consider doing so on soft surfaces like grass to reduce the impact on their feet.
