A colleague came to me two weeks ago complaining about a condition I rarely see in clinic, but which nevertheless, can be very disabling. It can be the underlying cause of many structural problems of the body and is often misdiagnosed.

The feet are our foundation and the main shock absorbers of the body. If this foundation is not functioning at its best, the body will display muscle and joint pains as well as more serious injuries.

The vast majority of people will have over-pronated or flat feet. Here the arch collapses, the foot has a hyper- flexibility, and it rolls inwards.

A rarer state to find the foot in is the opposite of over-pronation, which is over- supination. This is where the foot leans to the outside and the weight is distributed along the outer border. The arch tends to be high and the foot will lack mobility.

Over supination means the bodies shock-absorbing capability is reduced. Some people have a genetic predisposition to having this condition, while others may develop it as a result of injury or problems with their ligaments and tendons around the ankle.

DIAGNOSIS

To diagnose this problem we look at the wear pattern on shoes. The outer border will usually be more significantly worn, especially at the forefoot.

The foot print of a person with over- supination will differ from a normal one. A normal print will leave a mark showing the heel and forefoot joined by a strip that is approximately half the width of the foot. In an over-supinating foot, the strip will be much thinner, if there at all.

TREATMENT

Excessive supination increases the risk of injury by decreasing shock absorption. The impact to the muscles and the joints of the legs, hips and back will cause the patient’s overall alignment to be affected..

The first line of treatment is to correct the footwear and a podiatrist will be able to advise accordingly.

Supportive sneakers with shock-absorbing soles should reduce the impact of the injuries and stabilise the ankles. Orthotic inserts may also be suggested. These will attempt to correct the over-supination the heel and forefoot are posing.

Exercises such as calf stretches can help with the tight tissues underneath the foot. Patients with outer knee pain may benefit from massage to this area to release the tension within the tissues.

Patients should always consult a podiatrist or physiotherapist on how to correctly carry out these exercises.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974- 6339), Kingston (978-8392), and Savanna-la- Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.