ESCANABA — People like to pigeonhole, it’s something we humans have a tendency to. Are you a Republican or a Democrat? Are you a vegetarian or a carnivore? Some categorization is purely biologic: do you have type A blood or B negative? The same could be said for one’s foot type. Do you have a high or low arched foot?

Technically, this is asking if you are a pronator or a supinator: does your arch lower more or is it raised? These terms refer to some important characteristics of the human foot that have a tremendous effect on our musculoskeletal system, even our lives and livelihoods, our health and well-being.

There is a certain percentage of individuals who have a perfectly normal foot type with the proper alignment of joints, the correct tension on the multiple tendons and muscles. There are people with a perfect arch. But this is not the norm since most of us tend towards one side or the other.

In a different but very common scenario, the arch lowers when walking but otherwise is normal. Some pronation, basically lowering of the arch, is normal, proper, and healthy, but those with excessive amounts (referred to as pronation syndrome), tend to have problems associated with their poor biomechanics.

The joint below the ankle, the subtalar joint, is a critical player in this discussion. This is the articulation that allows the foot to move side to side. Motion of the sub-talar joint enables the foot to adapt to different surfaces. Another vital function of this joint is the absorption of shock, necessary with each step.

Again, pronation is a normal motion and occurs with each and every step. But in nature, as in most everything, too much of anything is a bad thing. Excessive pronation is responsible for a multitude of pathologies, from knee pain and degeneration to chronic back pain. A plethora of foot problems are correlated with the abnormal motion associated with pronation syndrome. But it’s essential to understand some pronation is required for normal and healthy gait.

The extra motion of too much pronation, like a tiny sprain, but one occurring with each step, ten thousand a day, three hundred and sixty days, will take its toll somewhere. The repetitive nature of this pathology is what leads to symptoms for most.

One consequence of pronation syndrome is reduced tension on the Achilles tendon, allowing it to shorten over the years. This change results in an alteration of gait and abnormal stress to a variety of structures. If you pronate excessively, you probably have a tightened Achilles tendon-muscle complex. Want to help your biomechanical functioning and musculoskeletal system? Stretch out your Achilles tendon (a task requiring inordinate amount of time to achieve).

Probably the most effective deterrent to excessive pronation would be some type of arch support. As regular readers likely know, this is a touchy subject. Just to be clear, an orthotic is a device that is custom-made. This means the foot, knee, elbow, or whatever structures is being fitted, must be scanned, imaged, casted, etc., in some way to be called an orthotic. Anything that is prefabricated, i.e. taken off a shelf, is not an orthotic.

Experts claim a majority of knee replacements could be prevented if the suffering individuals had worn properly prescribed foot orthotics years prior. Obviously, this is impossible to prove but the message is relevant. The feet are the foundation for the body, as the cliche so accurately proposes.

The time and expertise to properly prescribe and effectively fit a foot orthotic is significant, but the benefits to the musculoskeletal system, upon which we literally depend, are many. They can relieve pain, improve quality of life, enhance cardiovascular health, and more, all by reducing the deleterious consequences of too much pronation.

Of this fact, many Americans are thankful, standing and walking, going about their day. They are ‘hyper-pronators’ who are on their feet, with their excess pronation controlled by their prescription arch supports. But a more appropriate term might be their “body supports.” After all, these specialized braces, hidden away inside your shoe, are supporting everything, from the top of your head to the tip of your big toe.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.