Question
Do you have a preference for any certain off-the-shelf inserts for moderate to severe pronators to prevent injuries in young athletes?
Answer
I treat a ton of foot and ankle. That is where I love to be - there and the hip and shoulder. For a young athlete, I try to recommend as little as possible. But I do understand and I have seen young athletes whose feet need a little bit of support and a little bit of help. The insert that I recommend is a Superfeet®. It is a full length insert. Two-thirds of it has a more rigid support to it. It does not alter or change their mechanics. It is not putting any varus or valgus alignment or correction into the foot, but it is in fact giving it some support.
Usually what we see most often in our young athletes is severe pronation. What I like to do with these young athletes is to get them working on intrinsic strength. Not just toe curls, I like to do an exercise called a short foot. We all know our towel pick-ups and using our toes to pick up pencils; those activities usually work the flexor tendons of the foot. The short foot is more like an inch worm type motion. With the foot flat on the floor, I like to encourage them to raise the arch of the foot up, leaving the toes down on the floor. That helps to work some of the intrinsics of the foot to strengthen it a little bit more. I do a lot of gastroc soleus stretching because I feel if they cannot get the tibia over the top of the foot, they are going to go around it which may cause increases in pronation. The other thing I see is tibialis posterior weakness. Those are the three things. With your young athlete, I try not to get them out of my office with anything more than four exercises, and I feel so lucky when I can get them to do that many. I also have them do a lot of work on single foot balance activities with their eyes open, eyes closed, and with head turns left and right, up and down. My athletes are always looking up and down the field. I want to make sure that they have good vestibular balance reactions as well. When they are working on those single foot balance activities, make sure that they are strong all the way up through the kinetic chain with no lateral pelvic tilting or Trendelenberg. Make sure the hip is strong as well because that lateral hip stability can really contribute and help prevent a lot of severe pronation in the younger athlete.
