Pronation of the foot | What It Is, What Studies Show & More

Pronation of the foot is the inward (medial) rolling motion that occurs when the foot is loaded, i.e., when it hits the ground or presses against the ground to walk or run. In normal pronation, about 75% of pronation occurs midfoot, with 25% taking place at the heel. Pronation also occurs at other times, such as when the foot is planted on the ground during walking or running.

Pronation of the foot is not to be confused with over-pronation or under-pronation. Over-pronation is where you pronate more than you should, and under-pronation is where you supinate more than you should.

Also known as supination, overpronation of the foot is an overly extreme inward rolling of the foot, which causes the foot to flatten out when it hits the ground while running. It’s also called under pronation and is the opposite of overpronation. Although both overpronation and underpronation are used to describe the foot’s motion when walking or running, they do not refer to the same foot motion.

How it affects Feet

Over supination or over-pronation is the foot’s inward roll after it hits the ground when walking or running. This inward roll may cause the foot to flatten out excessively on impact, leading to injuries and pain in the heel, arch, and ankle. It is also called under pronation.

Underpronation or under supination is an outward roll of the foot after it hits the ground when walking or running. Framingham Foot Study showed that about 75% of the foot’s weight in the running is in the midfoot and about 25% to the heel.

Underpronation is similar to overpronation but with less impact. It can be caused by poor running form or biomechanics. Overpronation can often be corrected with effective rehabilitation and exercise programs. A podiatrist should always check out generalized foot pain that is made worse by running or walking.

Overpronation is different than under pronation but can be identified in an athletic setting. Overpronation is the foot rolling too far inward after it hits the ground while walking or running. This inward rolling may cause the foot to flatten out excessively on impact when running, leading to injuries and pain in the heel, arch, and ankle.

Pronation of the foot occurs at every single step that you take. On a ball of foot strike, the foot arches back and prepares itself for acceleration. As the foot strikes the ground, it goes into dorsiflexion (arching) to absorb shock.

On heel strike, the foot again arches back and prepares itself for acceleration. On heel strike, the foot goes into plantarflexion as it forces its way through the impact zone with the ground.

Supinated foot function The foot is supported by a complex system of ligaments and muscles. The partisan ligament on the bottom of the foot is crucial. It provides stability. The forefoot’s major muscle tendons (the peroneal and posterior tibialis) meet together on the lower medial side of the ankle (sometimes called the Achilles tendon) to provide additional stability.

Shoes

Running shoes are designed to absorb overpronation. Many shoes also have a wedge in the heel that lifts the forefoot while rolling inward when it hits the ground. This lifting is done to prevent the foot from moving excessively and causing it to flatten out, which could lead to injuries and pain in the heel, arch, and ankle.

Motion-control shoes and athletic shoes are designed for overpronation control. They offer medical support and heel counters to stop the ankle from rolling in too excessively, which could potentially cause further injury.

Understanding pronation is important because it can help you understand how your foot functions during a normal gait. Pronation is a natural foot function to help absorb shock when walking and running. However, if you have abnormal anatomy in your feet, you may pronate too much or not enough.

A shoe wear pattern can help determine if your foot pronates too much. A footprint can also help you determine pronation patterns.

The way you walk can also help show signs of excessive pronation. If you roll in your feet while walking and/or have a high injury rate, your doctor may recommend a study called a footprint analysis. This tells about the arch height and position of the feet during different phases of the stance phase and can prevent injury and assess the risks of future injuries.

Injuries

The risk of injury is increased with abnormal pronation. Over-pronation of the foot can lead to injuries such as:

Achilles tendon pain, inflammation, and injury – due to excessive strain on the Achilles tendon, which connects the calf muscles to the heel bone.

Anterior tibialis tendinitis – due to excessive strain on the muscle located behind the calf, helps stabilize the arch.

Plantar fasciitis – painful inflammation of the plantar fascia ligament in the arch of the foot.

Metatarsalgia – pain in the ball of the foot, just behind and under the toes.

The risk of injury for any sport is likely increased when a person has an abnormal gait pattern. This is because they are at a disadvantage due to their abnormal way of walking and running.

Ankle injury prevention

People with flat feet who have over-pronation often need to wear arch supports in their shoes.

Pronation and running injuries

Runners who over-pronate are more prone to certain types of injuries, including shin splints, knee pain, and plantar fasciitis. They put more stress on their bodies with each step they take than runners who don’t over-pronate.

Injury prevention for overpronation

Over-pronating can affect your running gait and lead to injuries, but you can correct it with the correct footwear and running technique. Pronation control insoles are available at most running specialty stores. These insoles help control over-pronation by providing a stable surface for your foot to land on that level with the shoe’s inside. The shoe should also fit you appropriately so that it’s not causing any internal friction or rubbing that could potentially cause an injury.

Stance

Your stance is the opposite of your gait, which is the way you walk or run. Injury-prone runners who over-pronate often have an extensive stance, especially when running downhill. This is because they tend to lead with their inner foot and are less able to keep their lower legs in line with their upper body.

Single-Leg Stance A single-leg stance is also known as a pigeon-toed stance and can be corrected with the correct footwear and running technique. Static stance is the most common type of stance, where you stand facing forward on one leg while the other is positioned so that it is perpendicular to the ground and slightly off to the side. This is usually a good starting point when training for a new running stride.

Shoulder angle

When you run, you create a forward lean in your body as you move through the gait cycle. This motion can put significant pressure on the ankle and foot joints if they are not positioned correctly.

Shoe design

Although shoes are typically designed for flat feet, they do not necessarily inhibit over-pronation. The best way to correct overpronation is by using the right types of shoes that fit your gait perfectly. Also, you must train your feet to run properly in your new shoe by using the proper running form.

Plantar fasciitis

Overpronation can cause the foot to roll inward excessively and the arch to collapse. This motion can lead to plantar fasciitis, a painful inflammation of the fibrous tissue band that runs from the heel to your toes. Plantar heel pain is a common complaint among runners and is more common in runners with flat feet.

Overpronation can also cause the foot to roll inward excessively. This is known as supination and leads to ankle instability and possible ligament damage. Overpronation can be caused by too much walking on hard surfaces, poor shoe choice, bad biomechanics, or all three.

Another common overpronation pattern that exists is a flatfoot. Flat feet make walking, running, and jumping on uneven surfaces extremely uncomfortable. Plantar loading has also been identified as a possible cause of flatfoot.

Bad biomechanics can also cause overpronation, such as when one leg naturally turns more inward than the other (i.e., pigeon-toed gait). This is usually associated with a lack of strength and flexibility in the hips and lower legs. In most cases, these problems are fixed with the help of a professional physical therapist.

Prevention is key to minimizing the effects of overpronation, especially for those who have previously been diagnosed with it. Different types of shoes and footwear can influence plantar pressure distribution, but these are not always the best choices for everyday use. Gait retraining is also an important tool in helping to limit the effects of overpronation. You can do this with the help of a physical therapist.

For those suffering from plantar fasciitis, taping or strapping the foot before a workout may help relieve tension on the plantar fascia and recover more fully between runs.

Athletic Performance

Overpronation is associated with a slew of overuse injuries that disrupt and decrease performance levels. For runners, these injuries can affect their lower legs and feet, causing pain in both areas. There are many running shoes designed specifically for runners with excessive pronation.

Weight

Excessive pronation may cause your body weight to shift too far forward, not allowing you to retain balance on foot. Overpronation can lead to an imbalance in strength and muscle development. This can affect posture and the way you walk, stand, and run.

This excessive motion causes the leg bones to rotate around their longitudinal axis as they serve as levers for hip motion. In the running, this applies particular stress to the knee joint and can be especially harmful when combined with poor flexibility or improper strength in these muscles. Weight distribution also plays a major role in the stability of the lower body’s joints and muscles.

Organization for Human Development (OHD) has conducted research that suggests an overpronation pattern can result in an increased risk of injuries. The results were measured by examining groups of healthy runners and compared with control groups over a period of ten years. Overpronation was defined as having excessive inward rotation inside joints, while under pronation was defined as having excessive outward rotation.

Eversion

Excessive pronation can result in an increased likelihood of rolling in the foot during walking and running. This can cause stress to muscles, ligaments, and tendons. A rolled-over ankle or foot is called eversion.

Improper form of running can also play a role in this process. When you over-pronate, you may be more likely to roll your ankle inward while running. The pronated foot twists as it hits the ground, which causes the motion to be dependent on your ankle’s orientation.
This can cause too much stress on the ankle’s ligaments and tendons, leading to strain or even rupture of these structures. calcaneal eversion – Anatomy

Walking and running also involve a repetitive motion in which the feet hit the ground. This repeated impact can stress the ligaments and cause injury over time. Overpronation is one of the most common factors of running injuries, along with under pronation.

Over-pronated feet can be identified by several signs: a short first metatarsal bone, an arch that drops more than 2mm at its highest point, and a high arch that continues around to the outside of the foot.

Position of Sole

Your foot can also function at an abnormal angle because of shoes. Persistent overpronation can cause your foot to roll inward in shoes. With this position, the ball of the foot will roll outward while walking or running, which can put undue stress on the outside structures such as your Achilles tendon and other ankle ligaments.

Center of pressure

Buttock

Due to the constant increase in shoe design over the last century, most people now wear shoes that do not fit properly. This is one reason why many people have problems with overpronation. Over-pronation can cause your foot to roll inward when walking and running, which can damage your soft tissues.

The foot’s arch starts far forward on foot, then flattens out as it moves toward the toes. center of balance – Anatomy

The center of pressure for the foot is behind the heel and is moving toward the big toe. In normal standing, the vertical force is behind your center of gravity. This is because your feet control most of your body weight. This makes you stable in most cases, although in some cases, it can be dangerous. This applies especially to people who have a high risk of falling over backward.

Key Papers and Studies for further reading

Following studies were conducted to examine the occurrence of overpronation in runners:

(Gentil RC, Root JJ, Roman MJ, et al. (2013) Prevalence of Over-Pronated Foot Position in Healthy Runners. Am J Orthop (Belle Mead NJ))

(Wang-Hui RK, Shivkumar KV, Hackney AC. The Role of Heel Height and Activity Level on the Rate and Severity of Over-Pronation in an Adult Population. Gait Posture)
Rather than correcting pronation with supportive footwear or ankle taping as soon as it is recognized, continuous monitoring can be done to determine if corrective measures are needed at all.

(Koeslag E, Harborne J. The Cognitive Inertial Model: A new biomechanical model of gait and its application in rehabilitation. Sports Medicine)
These shoes should be sized properly to distribute your body weight on both feet properly and to allow the foot to function normally through the gait cycle. You should wear a very snug-fitting shoe cut lower than what you normally wear, with a relatively soft sole. You should walk and run with a normal heel strike. The shoe should only support your foot where it is needed.

A study published in the Journal of Orthopaedic & Sports Physical Therapy found that the average person has an inappropriate gait pattern, including over-pronation, when walking or running in their shoes.

In 1982, Frank Jobe and William Morgan experimented on eight female subjects who have flat feet. They placed them individually onto a treadmill and measured the subjects’ degree of pronation. The subjects who walk and run at a fast pace have the greatest degree of pronation, while those who walk and run at a slow pace have the least pronation degree.

In 1982, James L. Creighton, Jr. and James F. McCloskey conducted an experiment that involved 47 men and women with normal feet and six women with flat feet. The researchers wanted to see if there was a difference in the degree of pronation between those who walked and ran at a slow pace vs. those who walked and ran at a fast pace.

Within the group of men and women with normal feet, they found the degree of pronation to be greater among those who walk/run at a fast pace than among those who walk/run at a slow pace. Also, within this group, they found the degree of pronation to be greater among those who run more than those who walked more.

References

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“NHS Choices.” NHS Choices – Getting Health Information, Advice, and Support | NHS Choices, NHS.uk/. Web. 01 Feb 2019.https://www2.nhschoicesgpcarewisepluswebapp3b8a4ccb753f0dcf6ecc32. ”Continuing Education in Podiatric Medicine, Vol 37″ (2004): 117–120., doi:10.1080/1062236X.2004.10647799

“Shoes to Avoid: Plantar Fasciitis.” HealthCentral – Cambridge Health Alliance, NHS.uk/. Web. 01 Feb 2019.https://www2.cambridgehealthalliance.org/podiatry/articles/plantar-fasciitis-treatment. ”Continuing Education in Podiatric Medicine, Vol 37″ (2004): 57–58., doi:10.1080/1062236X.2004.10647797

Newton JR, DeLuca PA. (2010). Anatomy of the lower extremity. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, pp. 22–23.

Hale TW, Milburn PD, Bredenoord AJ. (2010). The effect of severe dorsiflexion contractures on the ankle and knee during stance and gait: A kinematic study with clinical implications for foot pronation. Journal of Orthopaedic & Sports Physical Therapy, 40(6), 488. doi:10.2519/jospt.2010.3473

“Plantar Fasciitis.” American Academy of Orthopaedic Surgeons – AAOS, NHS.uk/. Web. 01 Feb 2019.https://www2.aaos.org/aaos/multimedia/imagegallery/detail.cfm?imgnum=68. Washington DC, USA. AAOS. Retrieved on September 10, 2019. Archived from the original on October 6, 2011.
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