Overpronation has become something of a buzzword in foot health. Many patients arrive having either self-diagnosed it or having previously been told they have it, but what does overpronation actually mean?
Humans are a varied species, and the same goes for our feet. No two feet are exactly alike, and one way they can vary is their foot posture. Pronation refers to the inward rolling of the foot while standing or walking, whereas the opposite is known as supination, where the foot rolls outwards. Podiatrists often use a tool called the Foot Posture Index, which scores foot posture on a numerical scale to determine the degree of pronation or supination present. The term overpronation tends to be used when the degree of inward rolling is excessive for an individual.
In isolation, having a pronated or supinated foot posture is not usually a concern. We see it more as a natural anatomical variation within the population. Many people live issue-free with pronated feet. In fact, some elite athletes are recognised as having flat feet, demonstrating that foot posture alone does not determine performance.
When does it become a problem?
Pronation (or supination) becomes clinically relevant when it is associated with pain, injury, or an increased risk of recurrent injury. Understanding your foot alignment can help explain how pressure is distributed while weight bearing. For example, pronated feet that roll inwards may place increased stress on the muscles, tendons and ligaments on the inside of the foot and ankle, with the reverse happening for supinated foot postures, impacting the structures on the outside of the foot and ankle.
Foot positioning can also have an impact higher up the kinetic chain, altering pressure distribution at the knee, hip and back. Increased pressure through soft tissue structures over time may contribute to the development of injury and associated pain.
One of the most common misconceptions is that pronation itself is a diagnosis. In reality, it is simply a description of how the foot moves. Whether it requires treatment depends on the individual and whether it is contributing to pain or injury.
What can be done about it?
In the majority of cases, our first conversation with patients is about their footwear and the need for more cushioning and support. It is surprising how much of a difference the type of shoes you wear can make. Generally speaking, a running-style trainer is preferred, but depending on the injury being treated, specific footwear characteristics can help to offload and support struggling tissues.
Another treatment option which we strongly advocate for is participation in a home exercise plan. A gradual progression of targeted exercises over weeks or months can work to improve soft tissue strength. This allows muscles and tendons to better tolerate the increased demands placed upon them and may help reduce the risk of recurring injury.
Insoles, also known as orthotics, are a useful treatment tool in patients with pain and injury associated with their foot posture. Insoles aim to alter the distribution of pressure through the foot, helping to reduce strain on targeted tissues or joints and alleviate pain.
There are many different types of insoles, each with features designed to address different problems. Some are particularly useful for forefoot pain, others for medial or lateral foot pain, and others for rearfoot pain. The most appropriate insole depends on the person’s symptoms, activity levels, biomechanics and clinical assessment.
The key takeaway
Many articles and individuals unfairly pathologise pronation as something to fear, not recognising that it is uncommon to come across a perfectly neutral foot that sits exactly in the middle of the Foot Posture Index. A deviation from neutral foot posture alone does not warrant intervention.
However, if there is pain or an injury that may be associated with your foot posture, appropriate advice can be given to help redistribute pressure, improve comfort and alleviate symptoms.
Olive Giles (MRCPod)