Foot Pronation and Supination

Todd Sabol, MS, AT


We always hear people talk about knees and hips, but one thing (and I am guilty of this) that isn’t talked about enough is foot type and foot positioning. Improper foot positioning can affect anything from poor squat form, to walking around and being on your feet at work every day. Two-foot positions I want to talk today are pronation and supination. These foot positionings are not a single thing by themselves, rather, they are a combination of actions that commonly relate at the foot. Excessive pronation or supination can cause pain, long term biomechanical issues and more. On the other hand, it can cause completely no pain at all, but there are things you can do and look for to help actively improve your specific situation.

Before we get into specifics, if you are having foot pain, I would highly recommend you see a qualified medical professional to assess your feet in a weight bearing and non-weight bearing position and conduct a thorough gait analysis. Your foot position can change from when you are standing or sitting depending on the stress or weight of your body. Normal pronation is a combination of plantarflexion, eversion and abduction, whereas normal supination is a combination of dorsiflexion, inversion and adduction. Ideally when you walk, you should heel strike and roll forward through your toes with the arch relatively keeping its position but having some give to allow it to flatten a tad and absorb the force of the impact. When you toe off at the end of your gait pattern, your arch should regain its non-weight bearing position and act as a spring to help propel you forward. If your foot does not act like this, and your arch rolls in, or collapses medially, it is considered over-pronation. While normal pronation is required for proper gait, over pronation is when your arch collapses too much medially and this causes increased stress on the medial ankle, the first two toes, and can be a contributing factor in shin splints. Another worrisome aspect of overpronation is when the ankle is excessively collapsing medially, the knee can sometimes follow and predispose someone to being in a knee valgus or knock-kneed position more often than normal. This can also put that person at a higher risk of knee pain and non-contact knee injuries. Overpronation can sometimes be attributed to a collapsed arch or poorly activated intrinsic foot musculature.

When we look on the other end, excessive foot supination, we are looking at problems on the lateral side of the foot, ankle and leg. With this issue we see the rolling motion of the foot during the gait pattern veer towards the lateral side of the foot. Natural supination also happens and required during normal gait to help the toe-off and create propulsion. But if excessive supination is occurring, the lateral shift of the foot continues throughout the gait cycle and you do not bear much, if any weight on the big toe. This causes large amounts of force through the lateral toes, peroneals, IT band and can cause additional foot problems from the lack of force absorption.

If you want to see what kind of foot type you maybe you can always look at you wear pattern on your shoes, and especially if they are older shoes, you will be able to tell where the most force is being transmitted during your weight-bearing cycle. You can also take a look at your arches. People who over-supinate tend to have high arches and rigid feet, whereas people who have soft or supple feet and flat arches tend to be overpronators.

I would highly recommend you find someone who is trained in foot evaluation and gait analysis to check out your feet. They will be able to diagnose and provide rehabilitation suggestions for you to help combat these issues and even may be able to evaluate you to the point of understanding where these patterns have been stemming from. Sometimes foot type can be anatomical and other times it can be the product of poor mechanics, an injury or other modifiable factors that can be actively worked on. Regardless of what type of foot you have, I would take a high interest in your foot health, because at the end of the day we need to love our feet. They do a lot for us and we need to return the favor! Let me know if you have any questions about this article or other foot issues you may be having, and always remember to #HealByMoving.