My Technique for Adjusting the Excessively Pronated Foot by Mark N. Charrette, DC One can think of Chiropractic in terms of science, art, and philosophy. The art or application of Chiropractic technique is open to personal interpretation, innovation and uniqueness. What I am sharing in this article is the way that I am currently adjusting the excessively pronated foot. It s based on a serial distortion pattern. It is my firm belief that understanding the pattern is the key to adjusting and stabilizing the excessively pronated foot. It has been shown that four out of five people age 40 and older have excessive foot pronation. Most is bilateral but asymmetrical. The bones in the feet subluxate/misalign in a very depictable pattern, as does the lower extremity. The excessive foot pronation subluxation pattern is accompanied by internal tibial rotation; internal femoral rotation; and patellar subluxation (superior/lateral). This distortion ultimately causes an anterior translation of the pelvis. [Table 1] Table I shows the typical misalignment/subluxation pattern of the excessively pronated foot. [Note: the cuboid subluxates inferior and lateral and also superior and lateral (Fig. 1). This will be explained briefly under cuboid adjustment.]
I adjust the foot as a unit. This means I adjust all the segments into their normal juxtaposition. The order in which I adjust them in is: 1. Navicular 2. Cuboid 3. Cuneiforms 4. Metatarsal heads 5. Talus 6. Calcaneus 7. Fibular head The following is a simple and uncomplicated explanation of how I adjust the excessively pronated foot. All examples are on the patient s right foot with the patient supine. Protocols 1. Navicular Inferior and Medial Subluxation (Right Foot) The doctor will find point tenderness near the height of the medial longitudinal arch (plantar surface). Doctor stabilizes patient s right foot with left hand on lateral malleolus. Doctor contacts the contact point with thenar of right hand. The foot is then brought to its inversion
tension point. Doctor thrusts in a superior and lateral direction (toward lateral malleolus) with thenar of right hand (Fig. 2). 2A. Cuboid Inferior and Lateral Subluxation (Right Foot) The doctor will find point tenderness just posterior to the 5th metatarsal base on the lateral aspect of the foot. This is the contact point. The doctor contacts the contact point with the thenar of the left hand. Stabilization is via the right hand along the medial malleolus. The foot is brought to its eversion tension. Doctor thrusts in a superior and medial direction (toward medial malleolus) with thenar of left hand (Fig. 3). 2B. Cuboid Superior and Lateral Subluxation (Right Foot) Due to inversion sprains and ankle rolls the cuboid appears to subluxate in a superior and lateral direction. Probably the most common cuboid pattern, whether a pronation or supination pattern. Doctor contacts the cuboid area on the lateral aspect of the foot with distal interphalangeal joint of right thenar and rest of hand grasping right foot. Left hand
contacts directly over right hand. With doctor s hands on patient s foot, the foot is taken off the table laterally and placed between the doctor s slightly bent knees (Fig. 4). Thrust is achieved by doctor squeezing hands and knees in a lateral to medial direction along with extension of the knees. A characteristic loud audible well usually be heard. 3. Cuneiforms 1-2-3 -- Inferior Subluxation (Right Foot) I adjust the cuneiforms as though they were one bone. The doctor stands on the involved foot side facing the opposite leg. Left hand makes a U shape and stabilizes hind foot with doctor s left hand. Finger pads contacting medial aspect of calcaneus. The anterior/medial border of the hand contacts plantar surface of foot under cuneiforms. It is important to keep both forearms parallel to patient s tibia. Doctor tractions inferiorly on right foot with left hand as right hand thrusts superior (Fig. 5). 4. Metatarsal Heads 2-3-4 -- Inferior Subluxation 1-5 --Superior and Lateral Subluxation (Right Foot)
The doctor contacts the plantar surface of the foot with the thumb pads. On the 2nd, 3rd, and 4th metatarsal heads. Finger pads contact the dorsum of the foot over the metatarsal shafts. Thumb pads push superior as finger pads pull lateral and inferior. This squeeze is repeated 4-5 times (Fig. 6). 5. Talus Anterior and Lateral Subluxation (Right Foot) The doctor will notice point tenderness on or near the talo-cuboid joint. This is the contact point. A. Thumbweb Contact. Doctor places both thumbwebs over talo-cuboid joint with palms facing doctor. Talus is brought to tension by tractioning inferiorly and adding slight dorsiflexion. Thrust is via bilateral triceps contraction. Thrust is in an anterior to posterior and slight lateral to medial direction (Fig. 7). B. Little Finger Contact. With both little fingers overlapped on the talo-cuboid joint and fingers interlocked (thumbs on sole of foot), doctor brings talus to tension with inferior traction and dorsiflexion. Thrust is a scoop in an anterior to posterior and slight lateral to medial direction (Fig. 8). 6. Calcaneus
Everted and Plantarflexed Subluxation (Right Foot) Doctor contacts patient s calcaneus with palmar surface of left hand so that thenar is contacting lateral aspect of calcaneus. The right hand shakes hands with the foot. Left hand applies lateral to medial on calcaneus as right hand makes several clockwise, then counterclockwise, rotations (Fig. 9). 7. Fibula Posterior and Lateral Subluxation (Right Knee) The doctor will find point tenderness on the posterior aspect of the fibular head. This is the contact point. Doctor stands on lateral aspect of patient s right leg facing superior. Doctor takes a tissue pull with the metacarpal-interphalangeal joint of the left index finger in an anterior to posterior and lateral to medial direction. The metacarpal-interphalangeal joint should end up on the posterior aspect of the fibula head. It acts as a fulcrum. Right hand grasps patient s right ankle and approximates the heel to the buttocks. Thrust is via a very fast arch pushing the heel toward the buttocks in a posterior to anterior direction (Fig. 10).
Stabilization For short-term stabilization, figure 8 taping as shown is beneficial (Fig. 11). Due to the effects of plastic deformation on the soft tissue retaining mechanism of the arches (plantar fascia), a custom-made, flexible orthotic is recommended for long-term stability. Foot-Levelers provides a multitude of orthotic styles that support all three arches (medial longitudinal, lateral longitudinal, and anterior transverse) in their normal ranges of motion. [Tables and Illustrations] Bones Subluxation Direction 1. Navicular Inferior & Medial 2. Cuboid Inferior & Lateral or *Superior & Lateral 3. Cuneiforms Inferior 4. Metatarsals 2-3-4 Inferior 5. Metatarsals 1&5 Superior & Lateral 6. Talus Anterior & Lateral 7. Calcaneus Everted & Plantarflexed 8. Fibular Head Posterior & Lateral *Most common direction of subluxation in adults Table I. Excessive Pronation Subluxation Pattern About the Author
Mark N. Charrette, DC, is a 1980 summa cum laude graduate of Palmer College of Chiropractic. Over the past 23 years, he has lectured extensively on spinal and extremity adjusting throughout the United States, Europe, the Far East and Australia.