Varus Wedging: A Simple but Powerful Means of Seeing if Correcting Pronation will Help An Area Painful

     Many of my patients not only come into the office with foot and ankle injuries (my speciality), but want to know if I can help their back, hips, knees, shins, etc. I start the process by watching them walk, and run if they are a runner. I try to correlate their symptoms with gait problems seen (like over pronation, over supination (aka under pronation), short leg syndrome, tight or weak muscles, and other instabilities. If the patient presents with over pronation, and has symptoms that even can be loosely tied to that motion, I prefer to use a varus wedge of 1/8 or 1/4 inch to see if removing some of the pronation will help them. You can apply the varus wedge (here I am using 1/4 inch rubber cork from JMS Plastics) to any insole, here the patient had a blue Superfeet insole. The wedge can be heel only, orthotic length only, or full length, all depending on the location of the motion (contact phase, midstance phase, or propulsive phase).

If the pronation is only at heel strike (contact phase), then a heel wedge may be all you need. If the pronation is during midstance, then an orthotic length wedge is normally used. And, if the pronation is during the propulsive phase (or in a runner's forefoot strike pattern), the wedge has to go out to the toes. 

The photo above shows the bottom of the right orthotic (on the left of the photo) with an orthotic length varus wedge of 1/4 inch, and the bottom of the left orthotic (on the right of the photo) with a full length 1/4 inch varus wedge. I love to tell my patients that sometimes this wedges are more important than an MRI of the involved area as success in reducing symptoms can help with long term treatment.