Underpronation

[smoggy]

Now that the dark nights are here I have decided to (dare I say it) train on the roads a couple of nights a week. I've not adopted this approach before so decided to go to the local running shop and get a gait analysis before parting with my cash. Previous gait analysis results had always suggested I was neutral, so I was somewhat surprised to find that the results of last weekend's analysis pointed quite firmly towards underpronation. I'm not disputing the results of the analysis, however, it has now plunged me into a world of bewilderment.
As a 44 year old male runner I'm instinctively reluctant to purchase a pair of running shoes that offer a level of support that I've hitherto managed without. However, if I ignore the results of the analysis am I storing up future problems? My confusion is enhanced further by the ongoing barefoot/cushioning debate that has arisen since the publication of 'Born to Run.' I've asked for advice at my club and some advocate the minimalist approach whilst others firmly endorse that I need a shoe with support.
The reason I've posted this on the injuries section is that I seem to have had 'bad luck' with injuries over the past 3 or 4 months. I seem to have a constant stiffness on the inside of my right knee. When I'm running things are okay once I've loosened up, but the knee becomes stiff the following day. Last night I completed a tempo session on the track of mile repeats. Felt really good on the track - today my knee feels tight. I'm wearing Brooks trail shoes for the session. What I want to know is are the shoes the problem or should I listen to the results of the gait analysis and go for a shoe with support when running on road/track.

Any advice would be really appreciated.

Smoggy

[IanDarkpeak]

to be clear you say you are "under pronating" do you mean pronating or supranating(excuse the spelling)?

[zephr]

I would presume he means not pronating as much as a normal foot should do... ie the arch isnt collapsing, which, I would imagine means that the foot is kept in a constant state of supination.
at least, thats what I would imagine it means... *raised eyebrow and quizzical look*

[smoggy]

Sorry - I'll try and be clearer. Basically, the only term the guy in the running shop used was 'underpronation.' On the screen both of my feet were trending outwards with each footstrike. On returning from the running shop I did my own research and came across the term 'supination' that you both allude to. A couple of sites gave visual examples on typical shoe wear and tear of a supinator. I checked my shoes and seemed to fit this category, i.e. my shoes are considerably more worn along the outside edges. I've not had any problems with the arches of my feet. Sorry that I can only offer you my layman's view, but as I'd welcome advice.

[zephr]

to be fair, that is quite a difficult one... the first is that there is a slight problem with the knee, and it could be that the shoes aren't giving you enough support... however, equally, it could be that the issue is coming from the hips. (if there has been no knee trauma, the issue is highly unlikely to arise from the knee- its the foot or the hip).
Now, if you see someone who is trained to look for issues in the feet- they will find them. An awful lot of podiatrists will find issue with the way the foot strikes the floor- but only the better podiatrists will also look at the way the hips are working and see if there is a dysfunction there as well. Its a bit like trying to work out a chicken/egg principle.

The other issue you have is that not all foot scans/shop assistants are equal. Yes, you may have gone to see a pro, but equally, they may not be quite on the ball as they say they are, or they may not have seen the issue you have... and again, they are only looking at your feet, not your hips. If there is a slight dysfunction with the way your glutes are firing, or if there is something that isnt quite moving like it should, the dysfunction, although not an issue to begin with, is going to cause biomechanical inefficiencies all the way down your leg- it may be that it does something to your gait, that, again you dont notice, but then together, the issue in the hips and the secondary issue in the foot, might do something that causes the knee to "complain".

So. what am I trying to say?
If you have had no issues for the past few years, this is new, and you have only seen one person about the problem, see someone else. Not necessarily someone that has their sole interest- or experience- in selling shoes, but someone who has also experience in biomechanics, and hip issues.
there are 2 worst things you can do.
1- ignore it- the pain in your knee is telling you that something isnt right. If you dont listen, SOMETHING is going to go "clunk" and you wont be happy
2- immediately go out and buy a pair of correctional shoes. You might not necessarily need them, and running in a pair of shoes that are changing your biomechanics may be doing you even more long term "damage" to joints and muscles you didnt even know you had.

So.
get a second opinion before you go jumping to conclusions and buying stuff. and overall dont panic.

[smoggy]

Thanks Zephr. What you say makes a lot of sense and it conforms with the conclusion that I'd largely arrived at. I've a couple of running friends who work at our local James Cook hospital and they are trying to set me up with a podiatrist that understands sports injury. I agee with you, a second and professional opinion is needed. With regard to knee trauma, I must add that 14 yrs ago I tore my cruciate and medial ligaments in said knee. Periodically, the knee will go, usually as a result of a twist on the fells, putting me out of action for a couple of weeks. The pain this time is different, it has appeared gradually without any obvious twist or impact. As I've stated previously, it isn't stopping me from running but the subsequent stiffness during the next 48hrs clearly isn't right. As you say,something will go 'clunk' if I don't get this sorted.
Cheers.

[Mike T]

Lack of pronation is usually addressed by wearing cushioned shoes, not support shoes, to encourage pronation.

[Andy A]

Gait biomechanics is complex and there are many factors involved, its not just a matter of someone being pronator, overpronator or supinator.

A foot can move through a full range of pronation and still cause wear on the outside edge of a shoe. There are several ways this can happen but the easiest one to explain is whats called 'tibial varus' (bow legged below the knee) which is a bend in the tibia causing the ankle end of the tibia to be closer to the mid line of the body than the knee end. (I hope this makes sense) This causes a rearfoot varus where the heel contacts the ground at a more inverted angle than a 'normal' foot. After heel contact the joints in the foot will go through a full range of pronation (moving the rearfoot from an inverted to everted posistion), to try and get the big toe on the floor. If your joints are not very supple (being a 44 year old fell runner they probably arent) might not be enough to get the foot flat on the floor. The 1st ray joint has to planterflex to get the big toe on the floor, causing a high medial arch (which falsly suggest the subtalar joint and midtarsal joints are supinated).
Lots of sports shops use eversion (indicates pronation) and inversion (indicates supination) to suggest if a person is a pronator or supinator. But the above explains how your foot can appear inverted or slightly everted and still be going through a full range of motion. There are other factors that can cause the same effect coming fromthe knee, femur, hip and pelvis but theres not enough space to explain all of those here.

[IanDarkpeak]

Plenty of good advice above so i'll not add any more but will say that I used to make custom footbeds for skiers and for every 100 pronaters you'd be lucky (un) to see a single supinater.