ProKinetics® Insoles are not recommended for people who have pes Cavus feet or hypersupinate because of structural or neuromuscular abnormalities typically manifested by abnormally high (peaked) arches. This group of patients is fairly small.
Based on experience, we believe over 60% of people who have elevated first metatarsals try to correct for structural hyperpronation by subconsciously supinating their feet. This group is less understood because there is no structural reason for their supination. They naturally pronate while standing, but the wear pattern on their shoes demonstrate that they supinate when they walk or run. During a time, when the foot should be released to pronate, these patients muscularly brace their feet to hold them in a supinated position. Some people are stronger, compensate harder and supinate substantially while most people supinate between heel strike and flat foot, and put most of the pressure in the middle of the ball of the foot when the heel rises.
This group of patients do not present with structural deformities or anomalies indicating a supinated gait. For generally unknown reasons these patients brace their muscles in an attempt to maintain supinated feet. This may be a subconscious over-correction in response to hyperpronation, but to our knowledge, no study of this phenomenon has been done. Patients who "brace" typically present with tight calf muscles, often develop shin splints when running, indicating that these muscle groups are trying to compensate for the unstable feet.
Supinators respond well to ProKinetics® Insoles, but the forces are initially kept low (always start in 3.5mm) to initiate a relaxation of the neuromuscular bracing pattern. Once the bracing pattern starts to relax, the forces can be increased in accordance with the first metatarsal deficit (elevation of the first metatarsal).