What is Pronation and Supination?
Identify over pronation and supination and choose the right shoes to support your foot type.
by Brad Walker | First Published April 27, 2004 | Updated April 7, 2019
The two conditions we are going to concentrate on in this issue are pronation and supination. These two terms refer to the foots natural rolling movement while walking or running. This motion is sometimes called the running gait, and is described at the New Balance web site as…
“A unique set of actions and reactions that your foot performs while in motion to support, cushion and balance your body.”
What is Pronation?
Pronation refers to the inward roll of the foot during normal motion and occurs as the outer edge of the heel strikes the ground and the foot rolls inward and flattens out. A moderate amount of pronation is required for the foot to function properly, however damage and injury can occur during excessive or over pronation. When over pronation does occur the foot arch flattens out and stretches the muscles, tendons and ligaments underneath the foot.
The picture on the right (used from the Diversified Integrated Sports Clinic web site) shows a view of the right foot as if looking at it from behind. As you can see in the picture the ankle is over-pronating or rolling inwardly.
What is Supination?
Supination (or under-pronation) is the opposite of pronation and refers to the outward roll of the foot during normal motion. A natural amount of supination occurs during the push-off phase of the running gait as the heel lifts off the ground and the forefoot and toes are used to propel the body forward. However, excessive or over supination (outward rolling) places a large strain on the muscles and tendons that stabilize the ankle, and can lead to the ankle rolling completely over, resulting in an ankle sprain or total ligament rupture.
This time, in the second picture to the right (used from the Diversified Integrated Sports Clinic web site), the foot is over-supinating or rolling outwardly.
Over pronation and supination may cause a number of ailments that affect the foot, ankle, knees, hips and back. Some of the more common symptoms of over pronation and supination are listed below.
- Plantar fasciitis and arch pain
- Ankle sprains
- Shin splints
- Achilles tendinitis
- Heel pain
- Flat feet
- Patellofemoral pain syndrome and other knee conditions
- Hip pain
- Back pain
Prevention and Treatment
Pronation and supination are bio-mechanical problems, and are best treated and prevented with orthotic inserts. But before you run out to buy orthotics it makes sense to get the right advice on footwear, and the best advice I can give you, is to go and see a qualified podiatrist for a complete foot-strike and running gait analysis. They will be able to tell you if there are any concerns regarding the way your running gait is functioning.
After your running gait has been analysed, have your podiatrist, or competent sports footwear sales person recommend a number of shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent pronation and supination. And, if needed, invest in a pair of orthotic inserts to further prevent over pronation or over supination.
Choosing the right shoes
That brings us to the next point. What should you be looking for when purchasing a new pair of shoes?
- Choose a shoe that suites your running gait and foot type. Money spent at the podiatrist now, for a complete foot-strike and running gait analysis, will save you much heart-ache and discomfort later. Having a shoe that suits your foot type is the best prevention for injury and pain.
- When having your shoes fitted have both feet measured to ensure you get the most appropriate size, and remember, your feet are three dimensional. The length of your foot is only one part of a proper fitting, measure your feet for width and depth to get a better fit.
- When purchasing footwear make your purchase in the later half of the day. Your feet will swell during the normal course of a day, so avoid making a purchase in the morning as you may find that your new shoes are half a size too small by the afternoon.
- When trying on new shoes always wear the socks that you will be using with your new shoes.
- Never purchase tight fitting shoes in the hope that they will stretch or wear-in over time.
Apart from good shoes and orthotic inserts, what else can you do?
- A thorough and correct warm up will help to prepare the muscles and tendons for any activity or sport. Without a proper warm up the muscles and tendons around your feet, ankles and lower legs will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles.
- Strengthening and conditioning the muscles of the lower leg (including balancing exercises) will also help to prevent ankle and lower leg injuries.
- Flexible muscles are extremely important in the prevention of most ankle and lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of motion. To keep your muscles and tendons flexible and supple, it is important to incorporate stretches that will help to correct your biomechanical inefficiencies and imbalances.
Leaning Heel-Back Calf Stretch (1:19) Stand upright and lean against a wall. Place one foot as far from the wall as is comfortable and make sure that both toes are facing forward and your heel is on the ground. Keep your back leg straight and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Kneeling Achilles Stretch (1:27) Kneel on one foot and place your body weight over your knee. Keep your heel on the ground and lean forward. This stretch can put a lot of pressure on the Achilles. Ease into this stretch by slowly leaning forward. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
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Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Porter, D. Schon, L. (2008). Baxter’s The Foot and Ankle in Sport, 2nd Edition (ISBN: 978-0323023580)
- Wikipedia contributors. (2019, January 24). Pronation of the foot, In Wikipedia, The Free Encyclopedia.
- Burns, J. Keenan, A. Redmond, A. (2005) Foot type and overuse injury in triathletes. Journal of the American Podiatric Medical Association, 95(3), 235-241.
- Dahle, L. Mueller, M. Delitto, A. Diamond, J. (1991) Visual assessment of foot type and relationship of foot type to lower extremity injury. Journal of Orthopaedic & Sports Physical Therapy, 14(2), 70-74.
- Lundberg, A. Svensson, O. Bylund, C. Goldie, I. Selvik, G. (1989) Kinematics of the ankle/foot complex – part 2: pronation and supination. Foot & Ankle International, 9(5), 248-253.
- Nielsen, R. Buist, I. Parner, E. Nohr, E. Sørensen, H. Lind, M. Rasmussen, S. (2014) Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British Journal of Sports Medicine, 48(6), 440-447.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.