I have been to three different shoe stores here in the Bay Area, and each store person took a look at my current running shoes (I wear them during the day) and said that “I pronate.” One youngish guy (he had the look of an emaciated, long-distance college runner) wanted to sell me some “anti-pronation”, “motion-control” shoes and a pair of off-the-shelf orthotics. I politely declined his offer and later mulled my options at a nearby Starbucks. I am still kicking tires, and it seems that the minimalist shoe trend is less about the perils of pronation and more about the horrors of heel-striking. So, inquiring minds (and feet) want to know: what is the straight story about pronation?

by Dr. Steve Gangemi (aka Sock Doc)

Pronation has gotten a bad rap.This has been going on for years. But it makes little sense to point an accusing finger at pronation as the “cause” of many running injuries.

We all pronate.

During a normal gait cycle the foot rolls inwards, everts (turns out on its axis), and the arch flattens. This is pronation and the foot is very flexible and loose at this time, or should be. Then the foot becomes more rigid and turns outwards a bit and uses stored energy in the tendons and ligaments to push off the ground, hopefully as it is rolling over the big toe. This is supination. Any variation to this normal cycle of function can result in a problem.

These terms are often used interchangeably to diagnose why someone has a foot problem or injury. What about overpronation? The reality is that  it’s a symptom of a problem and may correlate with an injury somewhere in the body or be the result of overtraining. Overpronation (or lack of supination) as with most symptoms, is often treated improperly as the root cause of a problem, especially by those eager to sell runners orthotics or “anti-pronation” shoes.

Foot pronation is a necessary and important aspect of the gait cycle. It acts as a major shock absorber for forces that are applied to the foot. During pronation, the tibialis anterior and the tibialis posterior muscles are active in supporting the foot, especially the main arch. If there are imbalances in the lower leg muscles, particularly the tibialis posterior, then excessive pronation may result, or the failure to resupinate.

Artificially reducing normal pronation with orthotics and many types of rigid footwear decreases the foot’s ability to act as a shock absorber and adapt to the ground underneath. This can result in stress and injury to the foot and other areas of the body responsible for normal gait action – and that can even mean an opposing upper body limb whose natural movement is necessary during a normal gait cycle. That means if you don’t pronate and supinate correctly, you may end up with a shoulder problem, for example. In such a case, orthotics or motion-control footwear can now become the reason for a new injury as normal gait is disrupted and shock is artificially altered.

How do you know if you really overpronate? There are a few things you can do as a self test. First, look at the shoes you’ve been walking or running in for some time. If the outside of the heels are excessively worn out, then that is a sure sign you overpronate. Another test is to point your foot down as much as possible (plantar flexion) and then inwards. So point down and twist your foot inwards like you’re trying to point down to the ground with your big toe. If this causes some discomfort on the inside of your calf muscle, especially behind your tibia bone (the main bone of your lower leg), or in the arch of your foot, you may have excessive pronation. This movement is actually one of supination, but many people have a weakness in supination and therefore they excessively pronate. There is an imbalance between the two. A third thing to observe is how you stand. If you catch yourself standing on the outside of your feet (rolling one or both of your feet outwards while standing), then that is a sign that you overpronate. One last test you can do is have someone look at your Achilles Tendon. Normally the tendon should run straight down the leg into the heel. If the foot is overpronated, it will turn inwards.

If you overpronate what do you do? Don’t treat it directly because you are merely treating the symptoms and controlling your pronation will just land you another problem eventually. Many runners are told they overpronate because their podiastrist  diagnosed it or some guy at the local running shoe store told them so while recommending some trendy motion-control shoes.

You’re not going fix your overpronation with any orthotic, supporting footwear,stretching, or any other gimmick out there. Always look for the source, and since these common treatment regimens only treat the symptom, as overpronation is just that – a symptom – look to why you are not pronating correctly.

Muscle imbalances of the lower leg and foot are the main reason for improper pronation (and supination).  Wearing over-supportive shoes and/or orthotics will throw your body out of whack. Trying to control pronation and supination directly will only disrupt normal gait, balance, proprioception, and muscle response resulting in a new injury somewhere down the line. Correcting these muscle imbalances can be as simple as transitioning out of your orthotics or non-minimalist shoes to minimalist shoes and walking barefoot as much as comfortably possibly so your foot and leg muscles, and tendons and ligaments begin to strengthen and heal.

Another significant and perhaps more common reason for muscle imbalances resulting in pronation/supination problems is overtraining. Yup, too much stress will have a dramatic effect on the lower leg muscles, particularly the tibialis posterior muscle that supports the main arch of the foot. There is a common connection between this muscle and the adrenal glands, which is where the major stress hormone cortisol is produced. So high levels of stress result in high levels of cortisol and tibialis posterior problems and then overpronation. Shin splints and plantar fasciitis are two common injuries that accompany this problem too. Another adrenal gland hormone, aldosterone, is necessary for sodium regulation and electrolyte balance in the body.

If you’re training too hard and anaerobic too much then you’ll end up with cortisol and aldosterone problems, and you will overpronate as a result. So, chill out on the hard-core stuff for a bit, go back to more aerobic training, walk barefoot as much as possible, and get out of those over-supportive running shoes.

More on pronation and supination, go here.