Overpronation and beyond...

Pronation is a normal stage in the gait cycle. A child who neutrally pronates will initially strike the ground on the lateral side of the heel, as the child transfers their weight the foot rolls in a medial direction to ensure that the weight is distributed evenly. Neutral pronation is the most ideal, efficient type of gait pattern allowing the body to naturally absorb shock.

Overpronation refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leads to poor lower extremity alignment and can cause future orthopedic concerns.

With proper support via a simple insert or proper footwear, the alignment can be corrected and child can develop functional movement patterns efficiently and with the least amount of undue stress on their body.

Over time Overpronation can lead to: bunions, Hallux rigidus, Plantar fascitis, Metatarsalgia, chronic ankle sprains, shin splints, Achilles tendonitis, stress fractures, tendonitis, Chondromalacia, Patellar-Femoral pain syndrome.

Treatment Ideas to come…


Torticollis comes from the Latin for “twisted neck”. A child with torticollis will present with their head tilted towards one side with chin turned to the other. In more technical terms, torticollis causes a lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.

Congenital Muscular Torticollis is the diagnosis applied to the majority of pediatric patients that we as Pediatric Physical Therapists will see, and it is due to a shortened sternocleidomastoid muscle. The tightness may be due to the child’s positioning in utero or some muscular damage done during delivery. Congenital Torticollis affects 1 in 250 infants.

Plagiocephaly (or the flattening of one side of the head) is a common occurrence in children with torticollis. Because the child spends the majority of their time on their back, with their head titled to one side, the head becomes flatter on the side which bears the weight. Facial asymetry may also occur. Treatment to address the torticollis will also address the plagiocephaly. With active exercise in prone and proper positioning of the child, the child’s head shape will become more symmetrical and the plagiocephaly will resolve

“With timely medical care most cases of Congenital Muscular Torticollis (CMT) can be resolved or dramatically improved. The best treatment involves a multidisciplinary team that involves swift referral, accurate assessment and differential diagnosis, specialized Physical Therapy treatment, and in some cases surgical intervention.” Diane Damiano, PhD, PT

Differential Diagnosis

The diagnosis of CMT is usually made upon physical examination within the first few month. Visit your pediatrician if you suspect your child may have torticollis. We want to rule out non-muscular origins of the presentation, such as Klippel-Feil Syndrome(fusion of cervical vertebrae), scoliosis, brachial plexus injury, ocular damage, or other congenital neurologic conditions.

Treatment Ideas to Come…

Shoes for overpronation...

Shoe choice is a somewhat inexpensive and easy step toward addressing a child’s overpronation or other gait abnormalities which result from low dynamic arches. Before looking into orthotics, consider what type of shoes your child is wearing on a daily basis. Shoes can be integral in promoting alignment and allowing the child to develop functional muscle strength and movement.

Key words to stress when shopping for shoes:

  • Support and Stabilize
  • Arch support
  • Medial post
  • Heel cup
  • Cushion ground reaction force
  • Motion control

Shoe Options

1. Brooks Kids Adrenaline GTS: provides maximum stability and responsiveness

2. Brooks Kids Defynance: improves heel-toe transition, stability and cushioning for low arch

3. Brooks Kids Addiction: designed for excessive over-pronator, midsole cushioning, good shock absorption and dual density post at medial arch

4. New Balance 760 (for children): medial post with shock absorbing mid-sole

**To check for proper fit, assess child’s gait with and without the shoe, look for alignment specifically knees over toes when performing squat to stand, step up and step downs as well as stair climbing.