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How physical therapy can help with foot issues in children.

by on October 22, 2012

How PT can help biomechanical foot issues in children


It has come to that time of the year when we are celebrating Physical Therapy Month in October.  We would like to take this opportunity to educate parents on a very common biomechanical foot issues that may be treated here at MOSAIC Children’s Therapy.  The foot conditions are called over pronation and over supination.

As a physical therapist, over pronation is much more common, but we see and treat both conditions in our clinic.

When we take a step, the outer edge of our heels hits the ground first and our feet normally roll inward to absorb part of the impact.  According to the Stretching Institute, this is called normal pronation.  Conversely, as you lift your foot and push off for a new step, the foot rolls outwards so that the toes and forefoot can retain traction. This is called supination of the foot.  Both a moderate amount of foot pronation and supination are needed for our feet to function correctly.

According to the Sports Injury Clinic, over pronation is a common injury and one that we see often as physical therapists.  It is more common than an over supination problem as mentioned above.  When an individual over pronates the foot rolls too far inward and most of the arch touches the floor.  This then causes the entire lower leg to roll inward, which then rotates the hips, knees, and ankles inward.  This places biomechanical forces on the body that may lead to athletic and other injuries.  It can also twist the spine, which may lead to a functional scoliosis which occurs from repetitive postures and positioning.

The picture above (used from the web site shows a view of the right foot as if looking at it from behind.  As you can see in the picture the ankle is over pronating or rolling inwards.


Over supination, also sometimes called under pronation, is based upon the same mechanics. However, a supinated foot rolls outward, which then leads to twisting of the foot and lower leg.  Over supination places more stress on the outer or lateral parts of the lower leg, hip, knee, and ankle. Excessive supination (outward rolling) places a large strain on the muscles and tendons that stabilize the ankle, and can lead to the ankle rolling completely over, resulting in an ankle sprain or total ligament rupture.


This picture (used from the web site shows a foot that is over supinating or rolling outwardly.

Over pronation and over supination may be treated and diagnosed by a licensed Physical Therapist, PT. It includes careful analysis of the patient’s walking and running  “gait patterns.” It also involves careful assessment related to lower body alignment, posture, and biomechanics.  Often, the physical therapist will then try and correct the improper foot and ankle alignment with either custom or non-custom orthotics or inserts that go into your shoes.  Careful assessment performed by a licensed PT will prevent many long term biomechanical issues related to wear and tear and improper alignment, breakdown of structures including muscles, tendons, joints, and ligaments, and prevent repetitive and overuse injuries in the future.

The physical therapist may also recommend certain lower body strengthening and stretching exercises, along with education, to keep the condition from worsening and improve the patient’s biomechanics.   During the evaluation, the therapist will also recommend the correct type of shoes and shoe-wear.   Physical Therapists here at MOSAIC see many patients with genetic abnormalities, developmental delays,  congenital diseases, Down syndrome, Autism, Cerebral Palsy,  pediatric sports and athletic injuries, and kids with poor or high muscle tone in which the above conditions are usually present.  If you are concerned about your child’s foot positioning and would like to have it assessed, an evaluation may be scheduled with our front desk.

We look forward to providing your child with physical therapy treatments, education, exercises, evaluation, and diagnostic testing that will help them!

Authored by:

Heidi L Kodeski, MPT

formerly of, Mosaic Children’s Therapy, Bellevue, WA


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