Pronation - Overview of Under & Overpronation

Do you experience pain in your arch, ankle, or leg that keeps you from doing all the activities you love?  Various issues with foot pronation can make getting from place to place difficult and even lead to more severe injuries. Whether you suspect or know that pronation (too much or too little) is your foot issue, we have created this comprehensive injury guide to help you on the road to recovery.

What is Pronation?

Foot pronation is the natural movement of the foot that occurs with the landing phase (when the foot touches the ground) during walking or running.   How your foot moves, lands, and absorbs the pressure of each step during the “pronation phase” of walking or running can be categorized into one of three groups.

“Normal” Pronation

Pronation of the foot is a completely normal and necessary dynamic movement. It involves three different planes of movement, including ankle dorsiflexion (bending), subtalar eversion (flattening of the arch), and forefoot abduction (toes pointing slightly outward). This three-dimensional move allows for proper weight acceptance and sets the foot up for an efficient push-off as you continue to move forward. 

Underpronation

Underpronation is also referred to as supination. The foot has difficulty properly pronating due to underlying issues like poor flexibility or a high arch. Ultimately, lack of pronation leads to excessive pressure on the outside of the foot during the landing phase of walking and running. This puts excessive strain on the entire foot and leads to faulty mechanics, which can lead to foot, ankle, and lower leg injury.

Overpronation

Another term for overpronation is hyperpronation. People with hyperpronation tend to have flexible feet, low arches, or flat feet that results in the frequent (and painful) ankle or foot rolls. The foot appears to be collapsing with each step, with too much pressure being exerted on the inside of the foot. This abnormal motion can lead to many different conditions like heel spurs, plantar fasciitis, and shin splints.

Causes of Overpronation and Underpronation

People who have hyperpronation of the foot, also known as overpronation or supination, typically can link the causes to either a structural problem in the foot or weakness in their foot, leg, or ankle. The weakness can be caused by poor-fitting shoes, an injury to the foot, or poor body alignment. The most common causes of hyperpronation are flat feet, pregnancy, and being overweight.

Underpronation is usually caused by an inherited problem or structural issue within the foot as well. Similar to overpronation, underpronation can also be caused by a weakness of muscles within the foot, ankle, or leg. Other common causes are poor shoes, previous injury, or a misalignment within the body.

Injuries Caused by Underpronation and Overpronation

If you are experiencing pain in your body it could be caused by excessive pronation of the foot and ankle. Anything from mild to severe overpronation and underpronation can cause multiple issues. This is because the way our feet move mechanically can influence every basic movement and lead to imbalances throughout the body, particularly the lower body and spine. Below is an extensive list of many of the injuries improper foot pronation can cause.

• Plantar fasciitis
• Shin splints, also known as medial tibial stress syndrome
• Back pain
• Heel spurs
• Heel or toe pain
• Stress fractures in the foot, ankle, or lower leg
• Iliotibial band syndrome
• Bunions (callus and alignment changes in the big toe)
• Patellofemoral syndrome (kneecap pain)
• Joint pain- including the ankle, knees, hip, etc. 
• Achilles tendonitis
• Ankle sprains

Symptoms of Faulty Pronation

The symptoms you experience with underpronation and overpronation can help guide you in developing an appropriate treatment plan. Your unique symptoms will be helpful in guiding your doctor and getting you back to running and walking without pain.

Running with Pronated Feet

For overpronation, symptoms may include flat feet, arch pain, corns or calluses, lower joint pain, and hammertoes. When your body is placed out of alignment with poor pronation of the feet it will affect the rest of your body. This is primarily because other areas of the lower body will have to work extra hard to absorb the impact of each step and coordinate moving forward in an efficient manner. 

Underpronation symptoms are caused by poor flexibility of the foot and ankle from a history of past injuries (time spent in a cast or boot) or genetics. You will develop tightness within your ankle, particularly of the calf and Achilles tendon, which can cause ankle sprains, fractures, and poor foot mobility. The most common symptoms are pain within the arch of the football of the foot. This can also lead to pain in your hip joints, lower back pain, and shin splints.

Pronation Diagnosis

If you suspect that you have overpronation or underpronation your first step should be to get a proper diagnosis from a professional. They will be able to assess your gait to determine if you need further evaluation. Your doctor, physical therapist, or podiatrist may assess you for pain, swelling, or deformities in your foot and ankle that could be contributing to poor pronation and supination of your foot and ankle.

• Self-assessment plan

  If you want to do a quick self-assessment before you seek a professional opinion we have a helpful plan for you!

  First, take a look at your shoes. Is the wear pattern on the bottom of your shoe on the arch side or outer foot side? If it is on the arch side then you most likely overpronate and if it is on the outside you probably underpronate.

  Second, take a look in the mirror as you stand to examine your arch. Is there space under your arch or is it flat on the ground? If it is flat on the ground you most likely overpronate. If it appears high and stiff (unable to flatten it purposefully) you most like underpronate.

  Lastly, get your feet wet. Step onto concrete or ground that will leave a watermark. If you see a complete footprint (no gap where you arch is) then you probably overpronate.

• Gait Analysis

  A gait analysis is a quick, non-invasive way to check how your feet pronate. This can usually be done at a running shoe specialty store or with a podiatrist or physical therapist. They will watch you from behind while you walk and run to look at your foot and ankle movement. This simple analysis from an expert can be incredibly helpful in choosing the best shoes and treatment plan for overpronation and underpronation.

• 3D Foot Mapping

  3D foot mapping is a system that analyzes your foot using laser and micro cameras. Your foot length, arch height, ball girth, and forefoot width are measured. This scan is used to help find the best shoes and arch support for your feet. Plus, it can help you effectively change your foot mechanics when possible too.

Recovering from Pronation Based Symptoms

Both overpronation and underpronation can both leave your entire body out of sorts and in pain. Your road to a full recovery from these will vary based on the amount you underpronate or overpronate and what symptoms you are experiencing. Keep in mind, the sooner you fix pronation issues the faster you will recover. For many people, abnormal pronation will be a lifelong issue that needs to be properly managed. For these people, they will need to wear custom orthotics or use another treatment device to minimize strain on their bodies.

Preventing Overpronation and Underpronation

Pronation issues (over or under) are an extremely common condition. If you are looking to prevent pronation the best way to do so is use orthotics, replace old shoes, and keep your feet, legs, and ankles strong and flexible. Faulty foot and ankle pronation doesn’t have to happen to you with the right prevention or can be better managed with the right insight. If you look after your body you can often prevent all the aches and pains that come with abnormal pronation.

Taking Pronation in Stride

Pain in your foot, ankle, and legs caused by abnormal pronation doesn’t have to slow you down. Have a professional analyze your gait to see if your symptoms might be caused by overpronation or underpronation. Once you have a diagnosis and understand any dysfunctions of your foot, take a look at our list of treatments to support you on your road to a full recovery. Your foot is the base of your body, don’t ignore your aches and pains because it can quickly lead to more problems!

Sources:

https://www.runnersworld.com/running-shoes/pronation-explained

https://www.medicalnewstoday.com/articles/320383.php

https://www.pedorthic.ca/foot-health/pronation/

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