Logan Steele
Pronation is a natural movement of the foot that occurs during walking and running. It is composed of three components: subtalar eversion, ankle dorsiflexion, and forefoot abduction. These motions occur simultaneously during the pronation phase, which is the first half of the stance phase of the gait cycle. The foot and ankle system is complex, consisting of 28 bones, 33 joints, 112 ligaments, and 34 muscles. The posterior tibialis muscle primarily controls pronation, and abnormal pronation can lead to injuries. This occurs when the foot pronates when it should supinate or overpronates during the normal pronation period. Overpronation is associated with overuse injuries such as medial tibial stress syndrome and knee pain. Treatments for overpronation include orthotics, footwear changes, and massage therapy.
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What You'll Learn
The posterior tibialis muscle
The tibialis posterior muscle is responsible for producing inversion of the foot and assists in plantarflexion of the foot at the ankle. It also plays a vital role in supporting the medial arch of the foot. Dysfunction of this muscle, including rupture of the tibialis posterior tendon, can lead to flat feet in adults, a condition known as adult-acquired flatfoot. Posterior tibial tendonitis, which involves inflammation or tearing of the tendon, is a common issue for runners and active individuals. It can cause pain, swelling, and potentially lead to flatfoot if left untreated.
To prevent or treat conditions associated with weakness in the tibialis posterior muscle, strengthening exercises can be performed. These exercises can be done in multiple positions and can utilise different equipment such as therabands and weights.
Abnormal pronation can be addressed through treatments such as orthotics, footwear changes, and soft-tissue massage. Exercises such as towel curls, marble pickups, and big toe stretches can also help improve ankle range of motion and reduce the impact of overpronation.
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Anterior tibialis
The tibialis anterior muscle is situated on the lateral side of the tibia. It is thick and fleshy above, and tendinous below, with fibres that run vertically downward, ending in a tendon. This tendon is apparent on the anterior surface of the muscle at the lower third of the leg. The tibialis anterior is the primary dorsiflexor of the ankle, and it helps to maintain the medial arch of the foot. It draws up and holds the toe in a locked position, and aids in any activity that requires moving the leg or keeping the leg vertical.
The tibialis anterior functions to stabilise the ankle as the foot hits the ground during the contact phase of walking. It also acts to pull the foot clear of the ground during the swing phase. It further functions to 'lock' the ankle, as in toe-kicking a ball, when held in an isometric contraction. The movements of the tibialis anterior are dorsiflexion and inversion of the ankle. However, the actions of the tibialis anterior are dependent on whether the foot is weight-bearing or not (closed or open kinetic chain). When the foot is on the ground, the muscle helps to balance the leg and talus on the other tarsal bones, so that the leg is kept vertical even when walking on uneven ground.
The tibialis anterior is one of the muscles that tend to be inhibited and underactive, which leads to the overactivity of the synergistic muscles: extensor hallicus longus, extensor digitorium longus, and peroneous tertius. People with an inhibited or weak tibialis anterior, for example, those with hemiplegia or Parkinson's, will have an abnormality in their anticipatory postural adjustment (APA) phase during gait initiation of the affected limb. Pain along the path of this muscle is often referred to as "shin splints" or medial tibial stress syndrome (MTSS). This pain is associated with small tears in the tibial periosteum, which is why stress fractures can occur as a complication.
Excessive physical activity, especially among runners and military personnel, can result in repetitive microtrauma of the tibialis anterior. This causes pain along the anterior edge of the tibia, known as anterior shin splints or anterior tibial stress syndrome. This pain generally resolves spontaneously during periods of rest, although non-steroidal anti-inflammatory drugs (NSAIDs) and ice may be used as a symptom-relieving treatment.
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Extensor digitorum longus
Pronation is the natural motion of the foot during walking and 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.
The extensor digitorum longus (EDL) is a muscle in the anterior (extensor) compartment of the leg. It is one of four muscles in this compartment, the others being the tibialis anterior, extensor hallucis longus, and fibularis (peroneus) tertius. The EDL is the most lateral muscle in the anterior compartment.
The EDL arises from the lateral condyle of the tibia, the upper three-quarters of the anterior surface of the body of the fibula, the upper part of the interosseous membrane, the deep surface of the fascia, and the intermuscular septa between it and the tibialis anterior on the medial side, and the peroneal muscles on the lateral side. The muscle passes under the superior and inferior extensor retinaculum of the foot and divides into four slips, which run forward on the dorsum of the foot and are inserted into the second and third phalanges of the four lesser toes.
The EDL, along with the other muscles in the anterior compartment of the leg, has the function of dorsiflexion of the foot. As the EDL crosses the subtalar, metatarsophalangeal, and interphalangeal joints of the foot, it also everses the foot and extends the toes. The EDL tends to be overactive and tight when the tibialis anterior is inhibited. Stretching and myofascial release of the EDL, along with activation of the tibialis anterior, can help to regain muscle balance and improve functional ankle dorsiflexion.
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Extensor hallucis longus
Pronation is the natural motion of the foot that occurs during walking and running. The foot normally rolls a bit inward with each step. The posterior tibialis muscle primarily controls pronation.
The extensor hallucis longus (EHL) muscle is a key muscle located in the anterior compartment of the lower leg. It is responsible for extending the big toe at both the metatarsophalangeal and interphalangeal joints. The muscle ends as a tendon of insertion. The tendon passes through a distinct compartment in the inferior extensor retinaculum of the foot. It crosses anterior tibial vessels lateromedially near the bend of the ankle. In the foot, its tendon is situated along the medial side of the dorsum of the foot.
The main action of the extensor hallucis longus is to extend the big toe, but it has accessory actions in other joints as well. It also assists with foot eversion and inversion. The muscle arises from the middle portion of the anterior surface of the fibula and adjacent interosseous membrane of the leg. The extensor hallucis longus is situated between the tibialis anterior and the extensor digitorum longus. The anterior tibial artery and vein and the deep peroneal nerve run between the extensor hallucis longus and the tibialis anterior muscles.
Weakness of the extensor hallucis longus can cause the toe to fold under the foot when pulling on socks or shoes and can cause tripping. Hyperextension of the great toe pulls the plantar plate distally, exposing the metatarsal head to excessive loads and producing pain. Similarly, hyperextension of the metatarsophalangeal joint pulls the interphalangeal joint into the toe box of a shoe, causing pain and calluses, or corns, on the dorsal surface of the interphalangeal joint.
Exercises such as the big toe lift, big toe extension with heel raises, and short foot exercise can help improve isolation and range of motion and strengthen the big toe extensor muscles.
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Muscles of the lower leg
The foot and ankle form a complex system, with 28 bones, 33 joints, 112 ligaments, and 34 muscles. The muscles of the lower leg are essential for various functions, including supporting body weight, providing balance, absorbing shock, and transferring ground reaction forces.
During pronation, the foot naturally rolls inward, with the weight shifting to the outside of the foot and then back to the big toe. This movement is part of the gait cycle, which includes three components: subtalar eversion, ankle dorsiflexion, and forefoot abduction. Pronation is necessary for the foot to propel forward properly, and it helps absorb shock and adapt to uneven terrain.
The posterior tibialis muscle primarily controls pronation. In overpronation, the ankle rolls too far downward and inward, causing the big toe and second toe to bear the brunt of the push-off during walking or running. This can lead to strain on the toes, instability in the foot, and increased rotation of the tibia, resulting in lower leg or knee problems such as shin splints and knee pain.
To address overpronation, treatments such as orthotics, motion-control shoes, and barefoot running have been suggested. Additionally, exercises like towel curls, marble pickups, and toe stretches can help improve ankle range of motion and reduce the risk of injuries associated with overpronation.
The muscles of the lower leg play a crucial role in maintaining stability and facilitating movement during various activities. By understanding the mechanics of pronation and its potential impact on the body, individuals can take preventive measures to maintain proper alignment and reduce the risk of injuries.
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Frequently asked questions
Pronation is the 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.
The muscles active during pronation are the anterior tibialis, extensor digitorum longus, and the extensor hallucis longus, all of which are supinators of the foot. The posterior tibialis muscle primarily controls pronation.
Overpronation occurs when the foot rolls too far downward and inward with each step, leading to instability in the foot. It is often associated with flat feet and can cause injuries such as shin splints, knee pain, and heel pain.
Overpronation can be corrected with motion-control shoes, orthotics, or insoles. Massage treatment can also be used to support other approaches such as orthotics and footwear changes.
