Pediatric:

Hyperpronation, if present, exists at birth but may not become symptomatic until later in life. Common findings will be present and may or may not be symptomatic. Generally speaking, the worse the deformity the worse the findings and symptoms.

Growing Pains

This is actually an inflammation of the lining of the leg bones. In a hyperpronating foot, the leg muscles must work. This overactivity leads to greater pull of the muscle on the leg bones. After a day of play and once the child gets into bed for the night and is no longer walking/standing, the inflammation set-in and pain ensues. No bone in our body will hurt when it grows.

Flattened Arch

This is a very common finding. If the child is sitting with their foot off the floor they have a nice arch, but when they stand the arch flattens. However, hyperpronation can also be present with a high arched foot.

 

Out-toed Walking

Normally the feet should point straight in front of the legs when walking and if viewed from behind only the fifth toes of the foot should be seen. In a hyperpronated foot usually greater than the fifth toes can be seen. This is referred to "too many toes sign".

 

Tip-Toe Walking

This decreases the muscle activity and is more efficient in a hyperpronated foot.

 

Structural Deformities

Many times children have bunions, hammertoes, etc. at a very young age due to the hyperpronation.

 

Not wanting to wear shoes

Sometimes the shoes will hurt their feet due to the excessive motion occurring, which rubs on the feet causing blisters and pain.

 

Abnormal Shoe Patterns

Due to the outward turning of the feet the outer sole of the shoe usual gets worn faster than usual.

 

Shoe laces coming untied

Again due to the excessive motion of the foot causing repetitive pressure to the sides of the shoes, which pull on the laces, eventually they become untied. Eventually the child will not want to tie the shoes in the first place or will get shoes without laces.

Always wanting to be held or sit down frequently when walking

Walking or standing is exhaustive due to the excessive muscle activity. After prolonged walking at the grocery store, shopping mall, or theme park the child with a hyperpronating foot will want to take very frequent breaks or if young enough will want to be held.

Poor posture

When the talus deviates, it alters the skeletal system affecting the knees, hips and back. When standing the back muscles try to compensate for this but only for short periods of time. Usually a child's shoulders will slump or they cannot stand on both feet for more than a few moments. Parents always try to reprimand the child but it is futile.

 

Knee, Hip, Back, Neck Symptoms

Any or all of these can be present in a child with a hyperpronated foot. Children should not suffer with these conditions at such a young age unless a deformity is causing this. Normally, these symptoms are associated after weight-bearing activities.

 

Inactive Child

If a child develops symptoms after a period of activity they will innately cease those activities. The parent will then try to force the child to be more active leading to frustration on both parties.

 

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Adult:

There are many more findings/symptoms present in adults since the deformity has been present since birth. Many findings will be present and depending on the activity level of the person and type of hyperpronation deformity will dictate the symptomatology.

 

Foot

• Bunions - Various deformities of the big toe joint including limited joint function.

• Hammertoes - Due to abnormal tendon pull of the toes.

• Neuroma - Caused by abnormal trauma to the intermetatarsal nerves.

• Ingrown Toenails - Usually present due to prolonged abnormal forces to the sides of the nail.

• Plantar fasciitis/Heel Spur Syndrome - Flattening of the arch leads to chronic over-stretching of the plantar fascia. The chronic pulling of the ligament on the calcaneus (heel bone) the bone will try to "grow-out" a shelf of bone to decrease the pull on the ligament. If the bone doesn't "grow-out" enough, symptoms will ensue.

• "Pump-bumps" or Haglund's Deformity - Bone spurs on the back of the heel due to abnormal pull of the Achilles tendon.

Ankle

• Tarsal Tunnel Syndrome - Nerve dysfunction to the inner ankle area due to chronic overstretching and impingement of the nerve.

• Posterior Tibial Tendon Dysfunction - Again, due to the flattening of the arch and repeated over stretching and activity on the pull of this tendon, inflammation ensues leading to chronic inflammation and disease of the tendon.

• Chronic Ankle Sprains - From the excessive rear-foot motion over-stretching of the ligaments leads to weakness, and if there is a sudden twisting of the ankle the ligaments are unable to prevent that excess motion leading to further injury.
  

Leg

• Shin Splints/Cramping - Adult "growing-pains" occur during/after exercise due to over-activity of the leg muscles to propel the foot.

• "Restless Leg Syndrome" - Occurs at night, due to the over-activity during the day.

Knee

• Anterior/Posterior Cruciate ligament Dysfunction

• Iliotibial Band Syndrome

• Lateral & Medial Collateral Ligament Dysfunction

• Meniscus Cartilage Damage

• Patellar Tendinitis

• Osteoarthritis

Hip

• Sciatica - Impingement of the large nerve from abnormal soft tissue adaptations.

• Joint Degeneration - Due to chronic inflammation from abnormal joint motion.

Pelvis

• Pelvic tilt - Compensation from abnormal hip motion that leads to abnormal back motion.

• Leg Length Discrepancy

Back

• Disc herniation/degeneration

• Spinal Stenosis

• Scoliosis

• Back Pain

Neck

• Strain/Stiffness

Head

• Migraines

• TMJ