Bracers tend to carry a more erect body posture, and their feet may sometimes be slightly adducted (pointing inward), but may also be straight or slightly abducted (pointing outward).
They tend to roll to the outside of their feet, are more prone to ankle injuries, and generally may complain about muscle pain in their legs (shin splints) and fatigue as the day wears on. They will usually display a rigid, jarring walk, and on examination you will find their body to be rigid as well. You will recognize them by excessive body tension.
If there is no other recognized pathology in the foot, knee and hip that causes excessive supination, bracers are typically hyperpronators in disguise.
Bracers respond to medial column support, but must start with modest ground forces. A small amount, (3.5mm) will cause bracers to start relaxing the bracing pattern. They will typically feel a decrease in body tension.
Bracers will initially reject high ground forces, but when their bracing pattern is relaxed, they will accept the same ground forces as releasers.
In-toeing and Out-toeing
In-toeing and out-toeing are commonly seen compensations for hyperpronation. However, they can be indications of trauma or primary pathology in the hip or knee joints.
In-toed walking is often observed as a compensation in children hyperpronating significantly. Typically their First Metatarsal Deficit (FMD) (elevation of the big toe) is over 20mm. When they turn their feet inward, it prevents their feet from hyperpronating by carrying the body’s weight on the outside of their feet. Many of these children may develop high arches and bowed legs as they grow into adulthood. Because it is traditionally and cosmetically unacceptable to parents to see their children walking “Pigeon-toed”, they often remind them to turn their feet outward. These children, as they turn their feet outward, typically become bracers. That is, they are substituting in-toeing compensation for hyperpronation for bracing compensation.
An out-toed gait pattern is a common compensation to lurching (lateral drift). Turning the feet outward serves two functions: (1) It increases their base of support and thereby diminishes the balance instability seen with hyperpronation, and (2) Turning the foot outward on one side more than the other diminishes the drift in that direction.
When we decrease the degree of hyperpronation, the in-/out-toeing compensations automatically decrease (doesn’t require intentional or volitional interaction by the patient for it to occur). This occurs because (1) It takes less energy to walk with the feet pointing straight forward than turned outward or inward (Law of Conservation of Energy) and (2) The compensations are no longer needed by the body to insure stability (keep the body upright at all costs to prevent possible trauma from a fall). If there is no primary pathology in the knee or hip, the amount of in-/out-toeing will diminish commensurate with the degree of increased mechanical efficiency. As the hyperpronation is decreased, the toes point more and more forward.