Rigid Carbon Plates

Painful conditions of the forefoot can often benefit from rigid carbon plate insoles that make the shoe stiffer to restrict motion and decrease pain. This is particularly helpful for osteoarthritis or hallux rigidus of the hallux joint, turf toe and Freiberg’s infarction.

There is two different types of these rigid carbon plates based on their width in the forefoot. The full width one is rigid across the entire forefoot where as the one with what is called a Morton’s extension only goes under the big tie which allows the other side of the forefoot to have some more movement.

These inserts are only 1.0 to 1.2mm thick so easily fit into the shoes without any issues. They do change the way you walk, so may take a while for people to get used to wearing them.

Abductory Twist

An abductory twist is a characteristic of gait that is commonly observed by clinicians. Many people when they are walking, just as the heel comes off the ground there is a sudden and small movement of the heel medially (abduction). Many clinicians do not consider this to be of much significance as it is just a sign of an underlying problem rather than a problem on its own.

There are many different causes of this abductory twist. One is that the big toe joint must dorsiflex or bend just as the heel comes of the ground so that we can move forward. If that joint does not want to bend, then the foot will abduct to get around the block at the joint. Another common cause is overpronation of the foot. This is when the foot is rolling inwards at the ankle joint and the leg is externally rotating trying to roll the foot outwards. As soon as the heel comes off the ground the foot suddenly abducts due to the twisting.

A medial heel whip is something that does get confused with an abductory twist, but they are different. The twist occurs just as the heel comes off the ground and the whip is more of a circumduction of the whole foot as it comes of the ground. While the twist and whip are in the same direction, they are very different things and caused by different problems.

The abductory twist does not need to be treated as it is not a problem on its own. It is caused by something and that something is the cause of the problem, so that needs treating rather than just the abductory twist. The treatment will need to be directed at either the cause of a block in motion at the big toe or the cause of the overpronation of the foot. This means that the treatment may take on many different possible alternatives, so there is no one treatment for it.

Supination Resistance

Supination Resistance

Supination Resistance is a clinical test that is used to determine how hard or easy it is to supinate the foot. The test was first described by Kevin Kirby DPM. The test is performed clinically by placing two fingers under the posterior part of the arch and using the fingers to supinate the foot and raise the arch – an estimation of how resistant the foot is to supination is made. This helps decide how much force is needed to come from a foot orthotic. If the supination resistance force is high, then if a foot orthotic is needed, then it will have to push hard to resist that force or it may be less likely to work. If the foot orthotic pushes too hard in someone with a lower supination resistance, then it might sprain the ankle as it pushes to hard for the foot.

The clinical test became more popular in response to the understanding that “overpronation” was not the problem that is was widely assumed to be and the realization that it may not be the motion of pronation that is the problem, but more the force that are associated with that overpronation. The forces that are associated with the forces driving pronation are assumed to be the same as the forces needed to supination the foot, hence the name for the clinical test of supination resistance. There is also the understanding that forces are what does the damage to the tissues and not motion that does the damage. One study has found a very poor correlation between the posture of the foot and the forces needed to supinate it.

The test is associated with several different pathologies. It tends to be much harder to supinate a foot in those with posterior tibial tendon dysfunction and much easier to supinate the foot in those with peroneal tendonitis. Other pathologies and conditions are not related to the test.

There has been plenty of discussion on Podiatry Arena about the test. Probably the best summary and review of the evidence is this blog post by Craig Payne. This encyclopedic entry on PodiaPaedia is also worth checking out.

This video from PodChatLive talks with all those who have published research on the supination resistance test.


Severe “overpronation”

“Overpronation” is a commonly used and misused term by runners and health professionals in the context of running injuries and the use of running shoes. Pronation is a normal motion of the rearfoot in which the ankle rolls inwards and the arch of the foot collapses. This is what the foot is supposed to do as it is how the foot adapts to uneven surfaces and absorbs shock. It is healthy and nothing wrong with it. The way some runners talk about what they have read about it, you would think that they have some sort of disease.

Where the problem arises is that overpronation is widely considered a risk factor for getting an injury when running. For that reason, there are design features in running shoes that are claimed to help runners with this overpronation. These are what are known as the motion control running shoes. In contrast, the neutral running shoes do not have these design features aimed at helping the so-called overpronation.

The problem with the concept of overpronation is that there is no consensus on what is ‘normal’ and what is ‘over’. Some runners with severe overpronation get no problems and other runners with only small amount get lots of problems. The actual evidence linking overpronation to injury is also very weak. The consensus of the systematic reviews of the evidence is that it is only a very small risk factor, so it is not really a big issue due to so many other factors that go into runners getting an injury.

So should overpronation be treated? Yes, if it is contributing to the problem. No, if it is not contributing to the problem. This can be difficult to determine. A key in determining if it is contributing to the problem is to determine if the forces in the tissues that it is causing are high enough to damage the tissues. The supination resistance test can be helpful here in helping decide this. If that test is high, then the forces are high, so the overpronation probably should be treated. if the forces are low, then it may not be necessary to treat it. For example posterior tibial tendinitis could be due to overpronation if the forces are high.

If it does need to be treated, then the cause of the problem has to be addressed. There is not a one-size-fits-all when it comes to overpronation. If a muscle weakness is the cause of the problem, then exercises like the short foot exercise will help (it won’t help other causes). If tight calf muscles are the problem, then stretching is what is needed (muscles strengthening or foot orthotics will fail in these); if a bony alignment, such as forefoot varus, problem is the cause, then only foot orthotics will help (strengthening muscles and calf muscle stretching will fail); and so it goes on. The cause must be addressed.

There are so many myths and nonsense being perpetuated about overpronation. A key warning sign is that whoever is talking or writing about it is, if they advocate a one-site-fits-all when it comes to it, then they probably do not know what they are talking about.


Craig Payne on behalf of Croydon Total Footcare. Craig regularly lectures and blogs about this topic addressing the myths and nonsense. It is one of his pet peeves.