Are you a pronator? How bout’ an overpronator? Hopefully you’re the former and not the latter, though these terms are often used interchangeably to diagnose why someone has a foot problem or injury. However, overpronation is not the ultimate cause of any problem or injury, but a symptom of a problem and may correlate with an injury somewhere in the body or be the result of overtraining. Overpronation (or lack of supination) as with most symptoms, is often treated improperly as the root cause of a problem, even by well known guru “running docs” who like to tout that various injuries are because of overpronation.
During a normal gait cycle the foot rolls inwards, everts (the heel rotates slightly outwards), and the arch flattens. This is pronation and the foot is very flexible and loose at this time, or should be. Then the foot becomes more rigid and turns outwards a bit and uses stored energy in the tendons and ligaments to push off the ground, hopefully as it is rolling over the big toe. This is supination. Any variation to this normal cycle of function can result in a problem. Foot pronation is a necessary and important aspect of the gait cycle. It acts as a major shock absorber for forces that are applied to the foot. During pronation, the tibialis anterior and the tibialis posterior muscles are active in supporting the foot, especially the main arch. If there are imbalances in the lower leg muscles, particularly the tibialis posterior, then excessive pronation may result, or the failure to resupinate. We rarely hear that an athlete lacks supination, though if there is excessive pronation, there must be some supination deficiency. Maybe you’re really an under-supinator?
Artificially reducing normal pronation with orthotics and many types of footwear decreases the foot’s ability to act as a shock absorber and adapt to the surface underneath. This can result in stress and injury to the foot and other areas of the body responsible for normal gait action – and that can even mean an opposing upper body limb whose natural movement is necessary during a normal gait cycle. That means if you don’t pronate and supinate correctly, you may end up with a shoulder problem, for example. In such a case, orthotics or motion-control footwear can now become the reason for a new injury as normal gait is disrupted and shock is artificially altered.
How do you know if you really overpronate? There are a few things you can do as a self test. First, look at the shoes you’ve been walking or running in for some time. If the outside of the heels are excessively worn out, as shown in the photo below on the left, then that is a sure sign you overpronate. Another test is to point your foot down as much as possible (plantar flexion) and then inwards. So point down and twist your foot inwards like you’re trying to point down to the ground with your big toe. If this causes some discomfort on the inside of your calf muscle, especially behind your tibia bone (the main bone of your lower leg), or in the arch of your foot, you may have excessive pronation. This movement is actually one of supination, but many people have a weakness in supination and therefore they excessively pronate. There is an imbalance between the two. A third thing to observe is how you stand. If you catch yourself standing on the outside of your feet (rolling one or both of your feet outwards while standing), then that is a sign that you overpronate. One last test you can do is have someone look at your Achilles Tendon. Normally the tendon should run straight down the leg into the heel. If the foot is overpronated, it will turn inwards as shown in this photo below on the right.
So if you overpronate what do you do? Sock Doc says don’t treat it directly because you are merely treating the symptoms and controlling your pronation will just land you another problem eventually. Many people are told they overpronate because their doctor diagnosed it or some guy at the local running shoe store told them so while recommending some trendy motion-control shoes. If you’re a Sock Doc reader you know you’re not going fix your overpronation with any orthotic, supporting footwear, stretching, or any other gimmick out there. Always look for the source, and since these common treatment regimens only treat the symptom, as overpronation is just that – a symptom – look to why you are not pronating correctly.
Muscle imbalances of the lower leg and foot are the main reason for improper pronation (and supination). The muscle imbalances can be a result of many factors. One main reason for muscle imbalances in the lower leg is wearing over-supportive shoes and/or orthotics, as mentioned previously. Trying to control pronation and supination directly will only disrupt normal gait, balance, proprioception, and muscle response resulting in a new injury somewhere down the line. Correcting these muscle imbalances can be as simple as transitioning out of your orthotics or non-minimalist shoes to minimalist shoes and walking barefoot as much as comfortably possibly so your foot and leg muscles, and tendons and ligaments begin to strengthen and heal.
Another significant and perhaps more common reason for muscle imbalances resulting in pronation/supination problems is overtraining. Yup, too much stress will have a dramatic effect on the lower leg muscles, particularly the tibialis posterior muscle that supports the main arch of the foot. There is a common connection between this muscle and the adrenal glands, which is where the major stress hormone cortisol is produced. So high levels of stress result in high levels of cortisol and tibialis posterior problems and then overpronation. Shin splints and plantar fasciitis are two common injuries that accompany this problem too. Another adrenal gland hormone, aldosterone, is necessary for sodium regulation and electrolyte balance in the body. You may have heard the term hyponatremia before – more can be read here. If you’re training too hard and anaerobic too much then you’ll end up with cortisol and aldosterone problems, and you will overpronate as a result. So, chill out on the hard-core stuff for a bit, go back to more aerobic training, walk barefoot as much as possible, and get out of those over supportive shoes so you can lose your “overpronator” label.
Hi soc doc
I have been an overpronator since as long as I can remember…since being a teenager basically. I have been fitted for othortics after getting shin splints…should I be ditching them? Will walking barefoot/minimalist shoes simply improve my overpronation? It is quite bad and worse on one foot. What could I do (aside from orthotics) to improve my feet?
Walking barefoot will help with your balance and strength of your foot and leg muscles, and other areas too. Orthotics, as mentioned, will only support your problem. There may be other factors involved in your overpronation, but you can always try to wean out of the orthotics and start walking around barefoot and see how you do.
Soc Doc,
My question is, what should I do the rest of the time when I’m not training? I wear steel or compostie toe shoes for work 8 hours a day, five days a week, and there is a lot of standing and walking involved. I also ride a motorcycle…. a lot…. which is something I will not do barefoot or in minimal shoes. The one time that I tried running barefoot, I immediately noticed the difference as if my shin splints were going away with each step. ….and then I fealt the blisters. Moving beyond the blisters, I plan to train barefoot or wear mocs while training from now on, however I don’t want to undo any healing/strengthening while I’m at work or out for a joy ride.
Yeah, there are cases where you really need to protect your feet and you’re probably not going to want to wear minimalist type shoes on a construction site or somewhere where you can hurt yourself. So, look for work boots that protect but do not over-do the support. Taking the insoles out may help too. I’m not sure of the brands and what’s out there on the market, if anything currently. Hopefully with the minimalist movement we’ll see more and more in other areas rather than just running and walking. My friend took the insoles out of his ski boots and was skiing significantly better after doing so (though he then needed new boots because the removal of the insoles made the boot space too large). The blisters will soon go away so you’re on the right track.
My left foot is over pronated and the right is neutral. I used the water foot imprint test and determined my foot type. Walking barefeet gives me pain and a lot of stress on my archilles tendon compared to when wearing cushioned sports shoes(regular). Also in the morning it gets difficult to walk when i step out of my bed as the heels and tendons pain a lot. It usually takes me 10 mins of slow walking to get rid of the pain. I’m in to regular light physical activity which keeps me active.
Kindly suggest any cure and the kind of shoes that i should be wearing.
Thanks and Regards
Check out these 3 articles on the SD site; they will help you out.
http://sock-doc.com/2011/06/running-shoes-prescription/
http://sock-doc.com/2011/03/plantar-fasciitis/
http://sock-doc.com/2011/05/overpronation/
Thanks for your site, SockDoc. Love it. I have a puzzle, though: I supinate and then pronate. The arch of my foot is tight. My foot sort of rolls around the arch and then pronates in the front. I have metatarsal discomfort on the 2-5 toes, discomfort to the bone/tendon to the lateral part of the foot and discomfort to both sides of the ankle that then turns into achilles tendinitus. I might have Morton’s toe on that foot, too. I have rather low arches. I was doing the near minimalist running last year and the foot just sort of gave way this past spring after running too much and doesn’t feel any better after much rest (one I begin running, it begins to hurt again). In the past I’ve worn normal trainers, but any pronation support gives me medial knee pain. I’m a bit bow legged too on that leg. Prescription orthotics don’t seem to help, other than temporarily relieving the pain. I’ve tried about every over the counter orthotic, but they don’t work either. I’m stumped–supinating or overpronating, what type of shoes to wear. Walking barefoot and wearing old-time sneakers feels fine, but running aggravates it. The calf and hole leg is sort of tight when I go into a squat, I notice, but no knots in the calf, etc. I had terrible shin-splints as a kid, but grew out of them. I’ve run for about 24 years and am 51. Any thoughts would be greatly appreciated as my docs and I are just guessing now. x-rays for foot and mri of knee show no major issues. Oh, and if I twist my foot far around I have this weird tendon type of clicking. Right foot is fine all around. Thanks so much for any insights!
Thanks Ron. Sounds like you have a lot of instability in the lower leg and foot area based off your description of what your foot is doing. Are you walking for distance barefoot (or just around the house)? Are you running barefoot? And by “old time sneakers” are you referring to something such as a racing flat? Can you jump run in place – hopping from one foot to the other – for at least 10 times on the ball of your foot without letting your heel touch? If you can’t that’s a sure sign of foot weakness.
Last year while I was training for a marathon I began to have pain in my knee. After having an MRI done I was told that I had a fluid build up in my knee. I was sent to a physical therapist for further analysis. They told me that I had an overpronation issue initially. However, it wasn’t due to arch failure.
What they had me do was take 10 steps in place, and then look down at my feet. My right foot was consistently 10-15 degrees turned outward. From there it was determined that the root of the actual issue was that my hip muscles were not strong enough to keep my knee aligned while running.
I was prescribed a series of hip exercises that I was to perform. I was given specific benchmarks to know when I should be strong enough to run. I spent October-December of last year doing this until I was finally able to start running in January.
When I was starting to get to half marathon distances again this year I began noticing the similar pain in my knee. The pain lessened when I ran in a cushioned pair of Mizuno’s versus the Vibrams I had been wearing all year. From reading through your site it sounds like the Mizuno’s just did a better job of masking the pain/problem.
Do you think I need to be more proactive with additional hip exercises? Is there any cross training that would be better than just rotation exercises? Should I look for a different point in my body as to what the actual problem is?
Overpronation = weak tibialis posterior = knee pain. Due to overtraining, poor shoes, or both, in your case.
As you may know from reading this site, I don’t use or recommend any specific exercises until the muscles are functioning properly. Sometimes it is hard to know when this is without having a skilled physician evaluate you. But typically you will do better with addressing the muscle imbalances causing the hip problem by addressing the tight fascia of the glutes, hip flexors (psoas) and TFL (ITB). Once you deal with the fascial issues that are causing the muscles to be out of balance, then you can address the exercises. A lot of times just running and walking will be sufficient to rehab from then on out.
It sounds like you never corrected the injury. It just lessened with the rest and then was dampened with the Mizunos. So look for the trigger points in those areas like I show in the ITB video and also the Sciatica/Piriformis video (even though that’s not actually your problem). If you can’t get them yourself then look for a good massage therapist or rolfer of if you need a doc you can email me and I’ll see if I know someone in your area.
Thanks! I watched the videos and will rewatch them at home this evening and check the recommended areas.
Just going on recollection, I remember when I would go running in college I would often have to start walking because my “hip” was hurting. Based on your descriptions and what I recall the Piriformis may have been what was hurting. The pain always felt further back on my hip, and not right over the joint.
Similarly, during that time I would often have back pain. Mostly I would notice it in the morning when I woke up. I noticed this pain lessened when by getting out of bed when I first woke up instead of just rolling back over for some more sleep.
I’ll email you with my findings. We can see who you may know down in Florida.
Hi, Sock Doc,
I am a new runner-like brand new, training for my first warrior dash. I overpronate only in my left foot. I would say moderate to severe. I have all my life, I remember my grandmother thinking I needed corrective shoes as a child. I am thinking about going the minimalist shoe route and want to strengthen my feet/legs, are there any exercises I can do on my off days to strengthen my feet? I am having no acute pain anywhere right now, and just want to get started off on the right foot(pardon that awful pun). I want to prevent damage instead of having fix it. Also could my overpronation be due to a slight scoliosis? It never needed medical intervention, it is slight, but I notice things, for instance my right hip bone protrudes more than my left and the left side of my body has always seemed a little less stable. Would visiting a chiropractor help or hurt my situation? Thanks so much,
Rainey
The best thing you can do to get started is try to be barefoot as much as possible while at home and work. Walking and standing barefoot will do wonders for foot strength. Balancing on one leg will help too, not just the foot & ankle stability but also proprioception. Next you need to find a pair of minimalist shoes that work best for you. Check out models at Two Rives Treads and reviews at the Natural Running Center. (Both banners on home page here.) I wouldn’t think the scoliosis has much impact, but impossible to be sure w/o seeing you. I think everybody should have a good “body doc” whether that be a chiropractor, massage therapist, physical therapist, or rolfer – but finding a good one can sometimes be impossible.
I recently switched to the brooks pure project cadence from the launches and at first the outside of both calves would be very sore after running. It would go away soon after and felt more like soreness as opposed to injury. Recently, on longer runs I have noticed a pain in my left calf only. During the beginning of my run I felt a pain in my achiles but It moved to my calve by the end of the run. I definitely overstride with my right. My chiropractor says my left leg is shorter which I think is due to leaning on right more. I stopped going to him because after a day or so of adjustments the problem would return. I spend a lot of time barefoot so I don’t think strength is the issue just my stride. I also experience pain between my shoulders that radiates to my left shoulder the more I run. When I focus on bringing my shoulders down it sometimes helps but usually doesn’t last long. I used to slouch and have worked on it recently so I know that can cause trigger points. Who should I see to analyze my gait and is the pain inmy upper back/lowerneck due to my stride or posture. I sometimes feel it when doing front raises, trap exercises, handstands and other motions similar to those. Its a pinching pain that’s very severe for a short period of time. I usually can run through it but have to stop the particular lift when it occurs as it gets worse with fatigue. Thanks for the help.
Hey Chris, if the pain in your calves started when you began wearing the Brooks then you should switch to a different shoe. Typically, nobody is perfectly symmetrical – one leg tends to be a bit longer/shorter than the other, and isn’t a problem. The imbalance usually stems from the hips. Physical therapists love to tell their patients that one hip is rocked forward; chiropractors tell their patients one leg is shorter from a high hip. Either way it comes from some muscle imbalance somewhere in the body (not necessarily the hip, but usually), and is probably what is causing the shoulder problems too. There aren’t a lot of people who analyze the entire gait/musculoskeletal system as I do so I don’t refer out too much. But if you send me an email and I know someone who is closer to you (than me) then I’ll let you know.
I like to hike and do trailrunning and run thetreadmill. I have problems with my left foot. I can wear merrell hiking shoes, all day, but don’t like to wear them running. i have no foot pain with them, even though they aren’t very cushioned. I have horrible heel pain as my foot collapses inward in running sneakers. My ankles are narrow and foot bed wide. I have hadorthodics, etc. every shoe bugs my foot. As my heel collapses inward, i rotate my foot out and i get knee pain.
I don’t think i can wear those toe shoes, any suggestions? I used to be a huge brroks sneaker fan, but bought a pair of aasic stability sneakers on a whim and have been worse since..
thanks
Heidi, try walking and being barefoot as much as you possibly can as well as do one-leg balancing while barefoot. This will all help with the foot weaknesses you have. Maybe try Vivobarefoot shoes? I like them a lot and have the EVO review on this site. Many other zero-drop type shoes out there too. Stay away from stability shoes!
Which work for trail running in the woods and treadmill. I’m so confused and frustrated. This has been going on since I cant remember. and worse in the past yr. Sneaker shopping is frustrating, for me and my chiropractor boyfriend. What does zero drop mean?
Zero-drop means that the footwear is flat (no drop from heel to toe). There is info on this site about minimalist footwear and you can also check out the several minimalist and zero-drop shoe reviews over at the Natural Running Center.
Thank you so much. I love to run for 30 minutes but even as little as that is, it was excrutiating. Now I hope to be on the right track. Back to yoga for me!!
I definitely overpronate, the outside heels of my shoes are shredded quickly. I am 29, played college basketball, do CrossFit & Oly lift, and play basketball. Up until 25, never had any injuries other than shin splints mid-season of basketball. I did Erwan’s first MovNat seminar in the US, and do MovNat and usually work out barefoot or with minimal foot wear. Over the last three years I have had plantar fasciitis, patella tendonitis (both right side), SI joint issues (right side) and now have developed (what is currently diagnosed as) costochondritis in my chest. I thought the stuff on the right side may be related to overpronation or hip external/internal rotation flexibility – I work on it constantly (Mobility WOD, and various other hip/ankle mobility, but nothing seems to correct it. I also have noticed that what I believe is the tibialis anterior muscle is always very tight…Any thoughts on this?
On the costo? Any ideas? I have been to two orthos and a rheumatologist, I’ve had normal PT, strain/counterstrain, grafton, ART, dry needling, you name it….I am basically going broke trying to fix this…currently on naproxin, flector patch, and rest from the rheumatologist. Anything at all is much appreciated…Thank you very much for your time.
Also – I keep regular sleep pattern 7-7.5 hours during weekdays, 8 – 8.5 weekends. I always go to bed and wake up at pretty consistent time periods. I eat almost no grains, and limited sugars. I don’t do any caffeine, no alcohol, etc…
Hey Joe, good to see a MovNatter on this site! Honestly man, you’re broken. You’ve got so many compensations it’s now hard to distinguish between what’s real and what isn’t. I’m not saying they’re not “real” – I mean where do you start? It’s all related. And now you’re taking drugs, that sucks. Something is clearly causing your body to not heal properly. If the naproxen helps, (you feel better), then you have a fatty acid issue. If it doesn’t – then you shouldn’t take it. Where do you live?; you need a Sock Doc treatment.
Broken basically explains how I’ve felt over the last few years. I am in Cincinnati, OH
Also, forgot to mention Achilles Tendon tendonitis (both sides)…
Yeah sorry I don’t know anyone up there. Last person I referred to in that area told the patient not to stand barefoot on a hard surface because it was bad for his feet. So my referral list is slim. Feel free to get on my wait-list, you can always not take the appointment when it comes time to see you…
Am near Melb Australia can you refer to any likeminded practitioner?
Have problem with RF metatarsals that have at least 20 mth history, which is preventing walking distances etc. Have you any advice? I have started new thread but this area is probably more appropriate.
I replied to your Forum thread; I asked an Aussie doc I know if he knows anyone in Melbourne. If he does I’ll email you direct.
What effect would i expect with not being able to curl my big toe in my normal activities or foot function?
Can “fragmented sesamoids” /s (as stated in radiologist report) cause big toe not to be able to be curled? ( I can point down -now – after 20 mths of scrunching exercise!- and manually bend 1st joint 90 degrees but it feels as if there is no connection with which to make it curl under by itself.
The LF curls maximally) ? Wow this is new and hopeful… I just experimented with pushing it into curl “manually” and for the first time it did not flip straight back. ( maybe all the trigger point massages are changing things…)
Is this related to those sesamoid function after all? I also noticed a ripple below skin and tiny pain within ball pad near side foot as i contracted the arch to hold toe into curl position… and popping sensation/ sound where there was none before – at medial base of hallux near an arch muscle ending. Will watch this as dont know if good /bad sign !
I had incapacitating pain after an injury event for several days beneath the 1st MTP joint but it disappeared reasonably quickly and is not recurring even though the toe was left straight and immobile. (The Podi. was unconcerned at 7 days later that I could not curl the toe down :I )
Just prior to this i had new casual slip on shoes ( which were discarded after the injury!) that allowed my toes esp. big one to painfully hit the end. I was wearing different footwear when i ‘sprained’ the Hallux or whatever caused the pain and inflammation.
At least from that time i have been aware of numb and thick feeling at the #2 /3 MTP joints and numerous times attempted to straighten socks which felt as they had been bunched up there.
I cannot recall onset of rise to actual pain in the same region but believe it was from mowing approx 6 mths ago, in gumboots – using thick cushion socks, where there was a lot of foot stress as i began the regular mowing of a steep ditch and was bearing heavily thru my legs / feet to manage the weight. The RF was also squeezed a little at toe box due to wearing the thick socks – maybe a contribution??
Since Jan there has been improvement [which may have occurred if i had just simply rested it-???] with:
- high doses of anti- inflammatory nutrients incl Vit. C, Grape Seed extract;
- highly cushioned / shoes socks.
- later wearing ‘rocker’ shoes which meant i could walk and do daily activities without painful bending of the forefoot (the pad prescribed by physio underneath the metatarsals to disperse force away from MT heads caused massive pain after about 10 mins and was discarded)
- renewing orthotics (which although probably worsened condition for 4 weeks, as too long until this corrected, have decreased the pronation pressure when in the rockers -only)
I agree that the use of ‘rockers’ incl. the well known brand leader are ‘stupid’ philosophically they really impede movement let alone other considerations – i am just using them to function simply and somewhat without pain. I also agree re pronation issues now and to correct these outside of orthotics…
At present i feel at X-roads – i think i need to use foot ‘splints’ still at least temporarily when outdoors. I don’t want to re-injure or prolong the incapacity. but i also see I have to get imbalances diag. and treated.. I have a direction now thanks to your info..onward and upward
ps and ill also follow as per Heidi above “Heidi, try walking and being barefoot as much as you possibly can as well as do one-leg balancing while barefoot. This will all help with the foot weaknesses you have. Many Thanks for all the time you put into your sites its VERY appreciated
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Can I do better than this?