Leading Provider of Custom Orthotics

Category: Educational (Page 1 of 5)

Educational articles on how to relieve foot pain, knee pain, hip and back pain, plus so much more.

What is the difference between pronation and supination?

Supination severity diagram
Diagram showing difference between supination and pronation.
Illustration: © 2014 Dennis Homack, DC, MS, CCSP

It is extremely rare for someone’s feet and their stride to be perfectly balanced and equally weighted. Some people have feet that visibly turn inward or outward, while others have a subtler inner or outer weight distribution.

It’s hard to see, unless you look at the bottom of your shoes or have your feet scanned with the Foot Levelers Kiosk or other Foot Levelers scanning technology. (Click here to find a provider near you.)

Pronation and Supination

When bodyweight is placed on the outside of the foot while walking or running, it is known as supination. When the weight is placed more on the inside of the foot, it’s referred to as pronation. An easy way to differentiate and remember the difference is that supination has “up” in the word. In a proper stride, the foot should move from heel to toe with a person’s bodyweight evenly distributed on their feet, giving them neutral pronation. read more

How to Ease Pain Caused by Flat Feet and Arthritis

Many people think they are born with flat feet and that some people are simply, flat-footed. While it’s true that some people are flat-footed for most of their life, over time we all become more and more flat-footed since our arches collapse as we age. It’s possible that someone with flat feet feels no pain. However, if your arches collapse over time, causing your feet to become flatter, you will likely experience pain and discomfort.

Arthritis is another contributing factor to foot pain (as well as pain in other joints throughout the body), and flat feet and arthritis are often co-occurring issues. What many people do not realize when they are experiencing pain is that the source of their pain could be their feet, even if they’re having knee, hip, or neck pain. So, let’s discuss how custom orthotics are one of the best ways to ease pain caused by flat feet and/or arthritis. read more

Why Foot Levelers Custom Orthotics are the Best

The best custom orthotic

When you’re seeking out the best orthotics, whether you’re a healthcare provider looking for a reliable orthotics supplier, or a patient looking for pain relief, Foot Levelers is your best option. Let’s explore some of those reasons.


Our patented orthotics get results. Noticeable, long-lasting results.

Foot Levelers is a family-owned company that was born in 1952 when Dr. Monte H. Greenawalt invented Stabilizing Orthotics (that’s the technical name of our orthotics, more on that later). read more

Using Social Media to Grow and Sustain Your Practice

Social Media InfluenceMore than half of the entire world population is a Facebook user today, according to HootSuite. Facebook and its sister company Instagram are two of the leading social media platforms that can provide endless potential (and revenue) for business owners including chiropractors. These two networks are now our first stop for news, entertainment, communication, and purchasing. It’s no wonder that being an influencer is now a full-time career that can amass more than six figures a year. But as a chiropractor, you also have a major influence and strategically leveraging that on social media can help maintain and grow your practice. Here are some tips to help you. read more

3 Causes of Knee Pain and How to Get Relief

3 Causes of knee painAccording to WebMD,

Knee pain is the most common musculoskeletal complaint that brings people to their doctor.

The knee, in addition to bending and straightening hundreds of times each day, carries all of the weight of our body along with our hips and ankles. The knee is also distinctly different from other joints of the body because it also twists and rotates, making it even more susceptible to injury and discomfort. Additionally, the knee is made up of bones, joints, ligaments, and cartilage, so there are a lot of different areas that can be injured and irritated. read more

How Chiropractic Adjustments and Other​ Treatments Can Help the Opioid Epidemic

Chiropractic is a drug-free approach to pain relief and pain management

Opioid alternative through chiropractic adjustments and treatments

Currently, more than 2 million Americans are dependent on opioids. For many people, their addiction stems from seeking pain management for an injury or chronic condition, such as back or knee pain. The opioid crisis has become a national emergency causing overdose remedies to be sold over-the-counter for greater availability. Although some opioid abusers turn to hard drugs like heroin, many people develop dangerous addictions to prescription drugs originally provided to them by doctors they trust for treatment. However, opioids are not the only option for treatment and seeking chiropractic care provide patients with pain relief, but also aids in reducing the negative effects of the opioid epidemic on American society. read more

Have Low Back Pain? Look to Custom Orthotics First

Whole Body Health with Custom Orthotics

At least 80% of the U.S. population will experience back pain at some point in their lifetime, and more than 3 million reported cases of lower back pain occur each year. Lower back pain is also one of the biggest reasons why people miss work due to the intensity and sometimes sudden onset of discomfort and pain. However, there is a solution that doesn’t include endless trips to the doctor, arguing with insurance agents, prescription medications, and inconvenient physical therapy appointments.

Understanding Low Back Pain read more

Kevin Durant Achilles Tendon Rupture Most Likely Caused by Calf Injury

Kevin Durant Achilles Injury

In case you hadn’t heard, the world’s best basketball player, Kevin Durant, recently went down with an Achilles injury. It’s looking like (as we write this) it’s a ruptured Achilles tendon. That’s a devesting injury for anyone, let alone a world-class athlete.

Durant had been dealing with a calf injury, on the same leg, for a few weeks before this Achilles injury. He missed several games because of the calf injury and was in his first game back in action.

In a press conference after the game, the President of the Warriors, Bob Myers commented, “The initial injury was a calf injury. This is not a calf injury,” Myers said. “I’m not a doctor, I don’t know how those are related or not, but it’s a different injury.” read more

5 Reasons Orthotics Help Your Entire Body

Whole body health

Our body is an interdependent system and when one part is not functioning properly, it can negatively impact other parts leading to over or diminished use. Physicals exist because it is necessary to be examined from head to toe, literally, down to each and every toe, and specialists alone cannot effectively treat our entire body. Chiropractic medicine takes a holistic and comprehensive approach to the body to help ensure and optimize functioning so that we can live our daily lives more easily.

  read more

5 Terrible Things People Do to Treat Plantar Fasciitis

5 Terrible Things People Do to Treat Plantar Fasciitis

Plantar Fasciitis is an inflammation of the tissue in your foot and nearly 2 million Americans suffer from the discomfort of plantar fasciitis. Although many people think that plantar fasciitis affects only the heel of the foot, it can actually affect any part of the bottom of your foot since all of that tissue is at risk for inflammation. Early morning foot pain and/or stiffness is typically a good indication that you’re experiencing plantar fasciitis, as is pain or discomfort after spending long periods of time on your feet.  read more

How Chiropractors Can Fix Plantar Fasciitis

Chiropractor helping plantar fasciitis

With nearly 2 million American’s dealing with plantar fasciitis, it’s a very common problem that requires attention. Sadly, though, many people ignore their symptoms and discomfort until it becomes debilitating or until they have more time to get treatment. But, treating and alleviating plantar fasciitis can be as simple as seeing a Chiropractor and you can even take steps (no pun intended) to help prevent it from returning.

The feet are the foundation of the body. Problems with your feet are akin to having a sinking or cracking foundation in your home. It’s a chain reaction that influences how the rest of the body operates, but discomfort can also cloud your mind and negatively impact your mood and productivity, too. So how can you tell whether you have plantar fasciitis? read more

3 Bad Things Over-The-Counter Insoles Do to Your Body

3 bad things about over the counter insoles

Over-the-counter (OTC) orthotic insoles are foot supports made from various materials including foam, leather, and plastic. OTC insoles are designed to go inside your shoe and provide some type of relief. OTC insoles are popularized by clever branding and packaging techniques and can be bought at local pharmacies and grocery stores. Some are marketed as providing additional comfort. Others promise to relieve pain from common conditions like bunions, plantar fasciitis, and arch support issues. Additionally, you can buy OTC insoles for a variety of shoes like high heels, athletic shoes, and boots, so as to seemingly work with every consumer’s lifestyle. read more

Understanding What Makes Up the Best Pillow

best pillow for sleeping
The best pillow for sleeping is one that’s both comfortable and supportive.

Empirical Usage

People with chronic and/or acute neck pain are often overwhelmed with web pages, ads, emails, etc. about what is the best pillow for them. Most bedding stores have a line of pillows they tout as the best pillow to buy for neck pain.  Is there any scientific support for the claims made for better sleep, lowered neck pain, and headache relief? Which of the many different designs of support pillow is most likely to be helpful for most people?  Are there any risks or problems associated with the use of cervical pillows?  read more

Everything You Need to Know About Plantar Fasciitis, Including Whether or Not You Have It

Nearly 2 million Americans suffer from plantar fasciitis.

Heel and foot pain, spurs, tight tendons, and stiffness could be signs that you had a long day, you wore the wrong shoes, or that you have a common condition known as plantar fasciitis, along with nearly 2 million other Americans. For many of us living busy lives, we often brush off our own health unless or until we experience excruciating pain or some form of debilitation. But, foot pain, even a mild amount, is nothing to put on your to-do list for when you have time. The feet are the foundation of the body and when your feet aren’t operating at 100%, neither are you. Identifying, diagnosing, and treating plantar fasciitis can be fast and easy, leading you to have more comfort as you handle everything else in your life. read more

Foot Levelers Custom Orthotics Help World Champion Hopeful with Low Back Pain

Becci Holcomb is a strong woman. At age thirty, she has a retired USA Powerlifting deadlift record of 501 pounds and can squat 644 pounds. This is the equivalent of deadlifting a dumpster and squatting a large vending machine. In a sport dominated by males, Becci is stronger than many of the men.

Holcomb got her start in powerlifting while enrolled at Life University. She saw a flyer at school for the powerlifting club, and it got her interested. From there, a fellow student and powerlifter got her started. Becci quickly found out that she was a natural for which she credits to genetics and her upbringing.

Originally from the small town of Blanchester, Ohio, Holcomb comes from a family where she and her siblings are naturally tall and strong. Her father, Mike Holcomb, was an All-American wrestler and a member of the 1984 Olympic wrestling team. She grew up on a small family farm where carrying fifty-pound bags of feed was a regular chore. This helped her develop her physical strength even before she knew what powerlifting was, but it is Becci’s training and hard work that has gotten her to where she is today.

Becci trains 15 hours a week and works full-time as the Assistant Wellness Center Director at Life Wellness Center. For her, that means late nights and early mornings. She lifts five days a week and on Saturday’s commutes two hours, round trip, to train with her powerlifting coach. She also maintains a rigid diet, eating six small meals throughout the day. Holcomb is the first to admit that balancing work, training, and personal life takes a lot of discipline and commitment, but it has led to her success.

In her first competition, Holcomb placed second and qualified for nationals in her weight division. She broke and set new Georgia state records in squat, deadlift, and total. She would go on to win the USA Powerlifting Open Nationals three years later and qualified for the World Championships in Europe. Holcomb was ecstatic. She had placed second and third in both national and international competitions, but she had never won a national championship. 

 After returning home, Becci started to experience pain in her feet, hips, and back. Her joints were under a lot of stress. Becci sought out Dr. Joseph Haezebrouk and Dr. Paul Donaldson at Life University for advice and treatment. They recommended Foot Levelers custom orthotics which provide comfort for the feet, support for the whole body, and are clinically proven to help reduce pain. “The key to lifting, making the weight stick, and holding onto it is good stabilization and support from the ground up,” said Dr. Haezebrouk.

Holcomb’s feet were scanned and, upon reviewing the patient report of findings, the scan showed one arch was higher than the other with the left decreased in function. She was fitted with a pair of Foot Levelers custom orthotics and felt immediate relief. “I noticed a definite difference in my low back pain when wearing my custom orthotics. They are comfortable, and my feet, hips, and back don’t hurt,” said Becci.

“Having the proper support and alignment that Foot Levelers custom orthotics provide helps with the downward compression from the weight when your feet are off balanced and holding too much weight,” Dr. Haezebrouk added. “With Foot Levelers custom orthotics, Becci’s stability and posture improved and so did her pain.  She used to take several minutes to get off the exam room table, and now she slides right off.”  

Holcomb wears her custom orthotics from the moment she wakes up in the morning to when she goes to bed at night, having multiple pairs of custom orthotics to fit her different types of shoes. During the day she tries to live an active lifestyle. “I do a lot of hiking and walking and am always sure to wear my Foot Levelers custom orthotics,” Becci said. She even squats and bench presses wearing her Foot Levelers custom orthotics. “During training and competition, my squats are much more even when wearing my Foot Levelers than they were before.”

Competing in powerlifting is one of the most exciting things Holcomb has ever done. She says it is an adrenaline rush to lift heavy weights in front of cheering crowds. When she first started powerlifting, she did not know she would love it so much. Powerlifting has changed her life.

The most noticeable change has been in her body composition as fat mass has been replaced with muscle. However, the most significant difference has been in how she sees herself. Powerlifting has helped Becci develop a level of self-confidence and respect for herself. When she started lifting, she hated just about everything about her body. “I was always bigger and did not fit the mold for the average person. I went through some hard times as everyone does, but powerlifting has helped me grow and appreciate who I am as a person,” said Holcomb.

In April, Becci finished second at the USA Powerlifting Open Nationals to secure a spot in the 2018 World Championship where she hopes to set a new world record. However, for Holcomb, powerlifting has become more than winning championships or setting records. It is about being a positive example to women, especially her younger sisters, and letting them know that true strength is not how much you can lift but about being able to love yourself and your body. “I have younger sisters. I want to be able to instill in them that you don’t have to look a certain way to be valued and appreciated,” said Holcomb. “I want them to know that they are capable of so much and can-do amazing things.”

Are Your Patient’s Shoes Causing Pain In Their Body?

Musculoskeletal health is one of the largest costs in healthcare today. With one in two Americans having a musculoskeletal condition, the need for proper support and body alignment has never been greater. A recent survey found that most Americans today wear three pairs of shoes throughout the week. (1) Most of these shoes were not made to support their body, to fit their feet, and are harmful to their musculoskeletal health. Your patient’s health and freedom from pain are important for their quality of life and it starts with continuous support for their body from the ground up. 

Many consumers have been convinced, to get the proper support, it is only a matter of buying a more athletic, “comfortable” shoe. In 2015 alone, the athletic footwear industry generated $17.2 billion in sales according to the NPD Group. While athletic shoes being produced today may be more “comfortable”, the truth is they do not provide the support the body needs and can negatively impact posture and body alignment.

Most shoes, whether athletic or dress, are more fashion than function. When a shoe is designed, most are designed based upon a sample size. Typically, shoe companies use a men’s size ten and a women’s size eight shoe as their sample size. Manufacturers then add or subtract materials to create the larger or smaller sizes of the shoes. The outcome are shoes designed to fit and provide maximum performance for the sample size, not to each individually sized foot. (2)

Shoe companies such as Nike and Adidas have worked to remedy this. Nike’s new technology and foam sole enables Nike to make shoe sizes that fit the perfect size of the foot. This means each size is perfectly designed to maximize performance and no two sizes will have the same sole texture or design. While companies like Nike produce shoes that are made for different sizes of feet, their shoes still provide little or no support for the body.

Just look at the shoes your patients wear for evidence of the pronation in their feet. Shoes are designed to protect feet from the elements and adapt them to specific activities. They are not designed to handle the additional forces necessary to support the body. The shoes just break down. If you look at the extensive wear patterns, shoes show the evidence of the imbalances in the feet and the inability to provide the necessary support to correct them.

As a medical professional, it is vital for your patient’s health that they have the proper support no matter what shoe type they are wearing. Recommending multiple pairs of orthotics is critical to your patient’s musculoskeletal health. The effects of excessive foot pronation impacts everyone. While performing daily activities on their feet, your patients are most likely pronating wearing shoes that do not support their body. Without the proper support, their body will revert to the impact of the imbalances in their feet and, if not addressed, will cause pain in the knee, hip, back, and neck.

Far too many patients ignore and even put up with the pain caused by the poor fit and lack of support shoes provide for their body. Pronation in the feet combined with shoes that do not fit and that provide no support have a negative impact on the posture and alignment of the body. Patients who wear shoes without the proper support will regret their choice down the line. By recommending multiple pairs of custom orthotics, you can ensure your patients will have the continuity of support no matter what shoe type they are wearing. It will improve their health by helping them maintain proper posture and support and quality of life. 

  1. Robbins, Todd (2018, February 28). How Many Pairs of Shoes Do You Wear in a Week? Retrieved from https://98txt.iheart.com/content/2018-02-28-how-many-pairs-of-shoes-do-you-wear-in-a-week/
  2. Tepper, Fitz (2018, January 23). Nike Just Released Its First Shoe With An All-Foam Bottom. Retrieved from https://techcrunch.com/2018/01/23/nike-just-released-its-first-shoe-with-an-all-foam-bottom/

The Importance of Multiple Pairs

By Dr. Tim Maggs

The feet are the foundation of the body. Just like a house, when the foundation is not level everything that sits atop is not supported and is crooked. This means that normal foot mechanics can adversely influence the normal functions of the ankle, knee, hip, back, and neck. If left untreated, many foot conditions eventually contribute to health concerns up the kinetic chain.

This foot-spine-body connection is one of the most important and most common ones we see in our patients that walk into our office every day. After 40 years of practice and 17 years of digitally scanning every patient’s feet, my simple conclusion is that every human has some degree of arch collapse in their feet. No one is immune to plastic deformation, and the arches of the feet continue to collapse with age.

Genetics plays a significant role in the collapse of the arches in the feet. However, factors like shoe types, activity levels, and injuries can play a role. The shoes that people buy, whether they are athletic or dress, tend to provide minimal support for the feet. It is more fashion than function. If one looks at the bottom of most shoes, there is minimal arch support present. In most cases, the body goes years with imbalances and learns to compensate for the collapsed arches. This leads to pain in the ankles, knees, hips, back, and neck.

As an architectural structure, the feet are the foundation, and all work must begin thereby addressing the imbalances in the feet and the impact they are having up the kinetic chain. Using the Structural Fingerprint® Exam, we assess the biomechanical imbalances with every test. We do-leg length, muscle tenderness, joint mobility, digital foot scan and then the biomechanical x-rays. These assessments help demonstrate imbalances, fixations, distortion patterns and in many cases, dysfunction.

In most cases, the body has gone years with imbalances and has learned to compensate for the collapsed arches and the abnormal biomechanics. Re-educating the body is critically important, and that starts with Foot Levelers custom orthotics. Once Foot Levelers custom orthotics are introduced to the foot and shoe, the body will go through a re-education period. Just by wearing the custom orthotics, the feet are forced to exercise different muscle groups to align the body and provide full body support.

Re-educating the body is critically important and can only be truly successful when the patient has continuity of support in all their shoes. A study in Time Magazine found that the average person has 27 pairs of shoes. Due to the multiple shoe types we all wear, it is critically important to equip each shoe type with a custom orthotic. Without the continuity of proper support across shoe types, the body will revert to and compensate for the imbalances and diminish your patient’s outcomes.

This means that we as providers need to address that issue at our report of findings. Take the time to understand how many different shoe types the patient wears, walk slowly through the explanation of cost, and stand firm on the importance of wearing them continually. The continuity of wearing these supports cannot be over-emphasized. The result will be a win-win for you and your patient.

For all my patients, I start out by recommending two pairs. A recent survey found that 61% of respondents said they wore two or three pairs of shoes in a week. A great start is recommending one pair for their athletic shoes and one for their work or dress shoes. These two pairs of custom orthotics alone will cover a majority of their week and ensure that they have the consistent support their body needs no matter what shoes they are wearing.

Custom Molded, Flexible, Three Arch Custom Orthotics are an Effective Treatment for Plantar Fasciitis

Foot Levelers Plantar Fasciitis and Plantar Heel Pain

by Kevin Wong, DC

Our feet are perhaps the most overused and under-appreciated parts of the human body. We use them relentlessly, depending on them daily to bear our body weight, transport us places and allow us to stand, walk and run. Only in cases where they are painful do we bother to have them looked at. Even then, proper and complete knowledge of the feet, their movement patterns and their effects on the rest of the body are rarely adequately taught.

In the world of foot pain, heel pain and plantar fasciitis are among the most common ailments people consult a medical provider for. Up to ten percent of the population will present with heel pain over the course of their lives, and it can affect everyone who engages in weight-bearing physical activity. (1) It is important for the healthcare consumer to understand the various treatment options available.

Aside from physiotherapy modalities (i.e., cold laser, ultrasound, muscle stim, etc.), stretching/strengthening exercises and braces, foot orthotics are very often prescribed. The belief is the bottom of the feet are supported by an external device to “shore up the arch”.

British Journal of Sports Medicine

On March 19, 2018, an article was published by the British Journal of Sports Medicine (BJSM). The article was titled Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. It reviewed “current” literature and analyzed how effective orthotics were for plantar heel pain. In conclusion, the article found that there was no difference in improvement in pain or function between prefabricated, custom-made and sham orthoses in the treatment of patients with plantar heel pain.

Since the article’s release, some media outlets have released news reports discussing the article, but they have interchanged plantar heel pain with plantar fasciitis. Although the areas of involvement are close to each other, clinically speaking they are not the same and not synonymous. It is essential for patients and the public to know the difference so let’s make sure we define these terms as separate ailments.

Plantar Heel Pain and Plantar Fasciitis

Plantar heel pain is soreness or tenderness of the heel that has a location restricted to the underside or pad of the heel. It often radiates from the central part of the heel pad or the medial tubercle to the back of the heel itself.


Plantar Fasciitis involves inflammation or irritation of a thick band of tissue (the plantar fascia) that runs across the bottom of your foot from the heel bone to your toes. In this instance, pain is located anywhere on or radiate from the medial tubercle across the plantar fascia up to the toes. Here the plantar fascia gets excessively stretched and irritated.

Because of their location, plantar heel pain and plantar fasciitis are not the same thing. It may seem like splitting hairs, but in the study, we mentioned above, their findings made conclusions only for plantar heel pain, not plantar fasciitis.

The argument of which treatment(s) are helpful for plantar surface foot pain has been made for years by different health care providers and patients. Some believe there is no effective treatment for plantar surface foot pain while others vehemently disagree. It comes down to the patient and their specific situation. There is not a one size fits all treatment for Plantar Heel Pain and Plantar Fasciitis.

How to Treat Plantar Heel Pain and Plantar Fasciitis

To better understand what can be done to help these conditions, let’s take a look at the anatomy of the feet. The twenty-six bones of each foot are supported on the underside by three arches: the medial, lateral, and transverse. Most people only think we have one arch.

These three arches are fully formed by age seven, and together they are vital for supporting not only the feet but the ankles, knees, hips, pelvis and the entire spine above.

Now back to the BJSM Study. Recall, that the study evaluated existing research that had previously been published. The article found that there was no difference in improvement in pain or function between prefabricated, custom-made and sham orthoses in the treatment of patients with plantar heel pain.

If one analyzes the information in the study carefully, the type of orthotics that had been studied were custom made or prefabricated, hard, rigid, single arch support inserts. The orthotics in those studies were not custom molded, flexible and three arch support. There is a big difference between these types of orthotics and those classically made which are rigid.

The types of orthotics discussed in the study did not provide adequate support for all three arches of the feet. So, to be very specific, the study itself came to conclusions that are aimed explicitly at classic hard, rigid orthotic with one arch support.

When a custom molded, flexible, three arch orthotic is worn by the patient, it gives the appropriate amount of support for the feet. The three-arch support takes the stretch or elongating force caused by the overpronation or supination to the plantar fascia and reduces it significantly minimizing or eliminating the pain.

Pat McKee, a retired University of Toronto professor of occupational science and therapy, used to teach students how to make custom foot orthotics out of thermal plastics. She had this to say about custom orthotics and Plantar Fasciitis to CTV News: “Some (custom orthotics) are created better than others. I think it is better if they are shock absorbing and not a hard plastic.”

Custom molded, flexible and three arch support orthotics do the following:

1. Absorb 30% more ground shock with each step thereby reducing the stress on the ankle, knee, hips, pelvis and the spine.
2. Provide individual support for all three arches under each foot in all weight-bearing positions.
3. Help enhance the nerve sensation, circulation and muscle balance in the feet.
4. The reduction of stress in the joints above the feet will allow the muscles to fire in a healthier pattern, reduce nerve involvement and reduce pain.
5. Help prevent injuries in the joints of the body that arises from the repetitive stress created by over-pronation and excessive supination.

Ultimately, treatment for Plantar Heel Pain and Plantar Fasciitis comes down to the patient and their specific situation. Custom orthotics can be an effective treatment for Plantar Fasciitis. The types of orthotics discussed in the study were hard, rigid orthotics with one arch support and did not provide adequate support for all three arches of the feet. Custom molded, flexible, three arch orthotics give the appropriate amount of support and take the stretch or elongating force, caused by the overpronation or supination to the plantar fascia, and reduces it significantly minimizing or eliminating the pain.

Athletes and Hip Injury Prevention

hip painby John Danchik, DC, CCSP, FICC

The competitive and the recreational athlete can each be affected by injuries to the muscles and ligaments around the hip.  These injuries can significantly interfere with sports enjoyment and performance levels, and they occasionally will end participation completely.  Poor shock absorption and excessive pronation have been found to be underlying causes or contributing factors for many leg/hip injuries. (1)  Orthotics, which have been custom made to improve the biomechanics of the feet and reduce the extent of pronation, can help to prevent many sport-related leg injuries.

Excessive Foot Pronation a Factor

Busseuil et al. looked at the foot biomechanics of athletes who reported a recent foot or leg injury and compared them to an uninjured control group. (2)  The researchers determined that those athletes with more foot pronation had a much greater statistical probability of sustaining one of five leg injuries, including iliotibial band syndrome (which is due to excessive tightness of the hip abductor muscles).  This study helps us understand how providing appropriate orthotic support to patients who are involved in sport or recreational activities lowers their likelihood of developing both traumatic and overuse hip injuries.

In the Busseuil et al. paper, sixty-six injured athletes who ran at least once a week, and who had no history of traumatic or metabolic factors, were the study group.  Another (control) group of 216 athletes were matched who had no symptoms of lower extremity injuries.  The amount of pronation during standing and while running at “regular speed” was determined by measuring the angles of their footprints.  This quick and inexpensive method of determining the amount of pronation during functional activities (plantar prints) had been previously investigated. (3)

The investigators concluded that those athletes with more pronation had a much greater likelihood of having sustained one of the overuse athletic injuries.  While both the standing (static) and running (dynamic) prints showed some correlation, the amount of pronation seen in the static weightbearing footprint was the most predictive of developing an overuse injury.  This study helps remind us that it is very important to athletic performance and for injury prevention to check the alignment of patients’ feet in the standing position.

Hip Injuries and Hamstring Control

Many hip injuries develop from poor biomechanics and gait asymmetry, especially when running.  Smooth coordination of the muscles that provide balance and support for the pelvis is needed for optimum bipedal sports performance.  This includes the hamstring muscles and the hip abductor muscles, especially the tensor fascia lata (the iliotibial band).  When there is a biomechanical deficit from the feet and ankles, abnormal motions (such as excessive internal rotation of the entire leg) will predispose to pulls and strains of these important support muscles.  The hamstrings (comprised of the biceps femoris, semimembranosus, and semitendinosus muscles) are a good example.

During running, the hamstrings are most active during the last 25% of the swing phase, and the first 50% of the stance phase. (4)  This initial 50% of stance phase consists of heel strike and maximum pronation.  The hamstring muscles function to control the knee and ankle at heel strike and to help absorb some of the impact.  A recent study has shown a significant decrease in electromyographic activity in the hamstrings when wearing orthotics. (5)  In fact, these investigators found that the biceps femoris — which is the most frequently injured of the three hamstring muscles (6) — had the greatest decrease in activity of all muscles tested, including the tibialis anterior, the medial gastrocnemius, and the medial and lateral vastus muscles.  The authors of this study theorized that the additional support from the orthotics helped the hamstrings to control the position of the calcaneus and knee, so there was much less stress into the hip joint and pelvis.

Hip Injuries and Excessive Pronation

Using orthotics to correct excessive pronation and to treat hip problems requires an awareness of the various problems that can develop.  The following is a list of the pathologies that are seen in the hip and pelvis secondary to pronation and foot hypermobility: (7)

  • Anterior pelvic tilt
  • Hip adductor muscle strain
  • Hip flexor muscle strain
  • Hip joint capsulitis
  • Iliotibial band syndrome
  • Piriformis muscle strain
  • Tensor fascia lata strain
  • Trochanteric bursitis

These conditions will develop much more easily in athletes who push their musculoskeletal systems, in order to achieve greater functional performances.


Excessive pronation and/or poor shock absorption have been shown to be an associated or causative factor in many leg injuries — from the foot itself, up the lower leg to the knee, thigh, and into the hip joint.  The good news is that many of these conditions can be prevented with custom-made orthotics.  Evaluation of foot biomechanics is a good idea in all patients but is especially necessary for those who are recreationally active, or for anyone who has experienced hip problems.  To avoid potentially disabling hip injuries, competitive athletes must have regular evaluations of the alignment and function of their feet.  Additional preventive measures include wearing well-designed and solidly-constructed shoes.  When athletes are provided with custom-made orthotics, we chiropractors can prevent arch breakdown and biomechanical foot problems, and we can also treat numerous injuries to the lower extremities, including the hip joints.



  • Dahle LK et al. Visual assessment of foot type and relationship of foot type to lower extremity injury. J Orthop Sports Phys Ther 1991; 14:70-74.
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