Overpronation Is Really Not Your Problem

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 of the foot 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 of the foot.
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, that is common with those who overpronate because overpronators will often strike the ground hard on the outside of the heel before rolling in (overpronating). 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 can also 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. The arch of your foot has no relationship to overpronation.

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. Read how to properly transition out of your conventional shoes.

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.

 

Comments

  1. 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.

    • karenmilton says:

      Hi sock doc i hop you can help me i have a hip injury where i almost tore the muscle off the bone i have tried to climb back only to learn my alignment is out by 15 degrees i went to a podiatrist and he is making me custom made orthodics but he doesnt know weather i will tolterate it so what do i do could i be out that much i am walking like frankenstein my knee cap doesnt track well due to my tibia and fibula not tracing with the knee cap help me please tell me what i can do and who i need to see

        • karen milton says:

          Hi sock doc i am in a dilema about my condition it is going on twelve months nearly i have done everything right seen the right doctors had blood injections to try and heal the injury the needles were called rich plasma platletts i have had constant physio and have had so much rest when i had the last blood injection my specialist told me to try and walk so off i went only to learn i couldnt stride he told me that so we took it slow and then i learnt my left foot had falling arches due to the injury .

          Before this injury i worked out at the gym for eight years and was healthy and fit now i feel like everything i do is on top of me i am trying so hard to get back but this injury wont let me so now i am in custom made orthotics to correct my knees where i have a vmo problem what can i do and how long should i stay in orthotics i value your opinion and i am so keen to get back to the way i was my injury was the quadrackas femoris muscle at the back of my hip at the insertion of the hamstring with a compressed muscle pinging on the periformis is there hope for me as i am starting to feel like a cripple .

          I get so upset when nothing works for me i try to do exercises with a theraband from the physio i am not walking as i have unstable knees and my tibia and fibula are not tracking with my knees so i am in a real mess and i carnt see a way out of it i just want to positive help also my feet i never had a problem now i am to scared to walk barefoot even to go to the toilet from bed because i could roll my ankles and god knows i dont want anymore injuries it is going on twelve months on the 28th April .

          Please give me some advice on how to get back and what shoes to wear as i am so confused and i dont want to do anymore damage to my feet so i dont know what to do about the orthotics and how long to wear them for it is not natural i dont want a quick fix i want to fix the root of the problem .

          Thank you
          Sock doc please i am waiting for your reply urgently as i just want to start to get stronger not weaker everything i do goes against me for some reason

  2. 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.

  3. Shantanu Arora says:

    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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

      • Hello Dr.
        I am in a world of pain due to back/hip/butt/knee problems. Tight fascia of the glutes, hip flexors (psoas) and TFL (ITB). As a result, the tightness and friction has really caused a lot of cartilage degeneration on the lateral knee which I am having treated with stem cells. But until I address the root cause I’m afraid stem cells to rebuild the knee cartilage may be a waste of money. A massage therapist told me muscle stripping or dry needling would help. What should I do? And if at all possible, please please please recommend someone in the North Carolinas; preferably Raleigh, Durham, Chapel Hill area that could help. I don’t mind traveling further for relief and healing.

        Many thanks,
        Zett

        • I can recommend me in Chapel Hill.

          • That sounds great! I had no idea you were so close..yippee! Ok, so the million dollar question is “do you accept/bill Cigna insurance? I pray you do because otherwise it will be very difficult for me to afford such an outstanding practice as yours.

            I have one more question, if you don’t mind. What is your opinion on “dry needling” to release tight fascia? I have symptoms related to Greater Trochanter bursitis and can remember this is where I first started experiencing pain when playing tennis. My hip/gluteus muscles would become very fatigued and painful – then this moved on to the IT band friction syndrome which wreaked havoc on my outer knee. I desperately need your help to re-align my body/muscles.

            Thank you so very much!
            Zett

          • I don’t but your company might reimburse you.

            I think dry needling is the new hype in the PT world. I personally don’t see a need for it over other manual therapies, but I guess if a doc or therapist isn’t effective at using their hands or dealing with a problem via other means, then the dry needling may be a tool they need.

          • :-( to the insurance portion.

            May I ask what is your pay scale so I can budget accordingly? I definitely think you will be able to get to the root of my neuro pain due to muscle imbalances/weaknesses. Because now that I think about it, the pain started in the hip/greater troch region and then everything went haywire after that. I am very anxious to get started on a treatment plan and the road to recovery. Boy am I glad I found you!

            Thank you
            Zett

          • Hello Dr.
            If you don’t mind may I ask how you treat ITBS/piriformis problems? I was just curious to see if it consists of more than just recommending stretching and exercises; which are great…but I was curious if you also attack it from another standpoint. I am really looking forward to scheduling a phone consult with you since it seems that is the fastest way to schedule time with you considering the long wait list for an office visit.

            Many thanks for your prompt and very helpful feedback.

            God Bless
            Zett

          • Check out the ITBS video and Piriformis Video – both on this site.

  9. 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!

  10. 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.

  11. 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!!

  12. 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…

  13. 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.

  14. 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 :))

    Can I do better than this?

  15. PhilipV says:

    I bought a pair of minimalist shoes (the Merrell barefoots) in June 2011 and started doing morning runs and sprints (I had not been running before). I developed Achilles tendonitis (AT) in my right foot, which since then has been complimented by plantar fasciitis. Neither problem has resolved completely over the past 10 months, despite resting, seeing various physical therapists, using orthotics (the “Superfeet” brand), icing nearly every day, and adopting a strict paleo diet (I had not been eating processed foods, sugars, or caffeine anyways, but was a vegetarian for 15 years up until late November of 2011 and was eating a carb-heavy diet).

    After reading your article and investigating my feet, it is clear that I overpronate with both feet, even in normal walking. Your suggestions of getting rid of orthotics, going barefoot as much as possible, and favoring minimalist shoes makes sense to me. I do not want to continue to rely on orthotics, but I tried walking to work in Vibram FFs this morning and my calves got very sore very quickly. I am convinced that my overpronation was a major factor in my injury. My question for you is this: as the article here seems to be more directed toward those who are not injured but want to remain healthy, what would you recommend for those of us with overpronation problems who are ALREADY injured? Should we start walking barefoot just the same as someone who is not injured? Or is there something special that we must do (specifically as regards the transition to a more barefoot style of walking)? In your view, are orthopedics justified on a short-term basis—like, I wear them until my AT is gone, and then transition to barefoot walking?

    • First, make sure you’ve read or will read : http://sock-doc.com/2012/03/healthy-people-barefoot-people/ as it will answer some of your concerns.

      Getting to more minimalist while being injured is definitely going to be more work than if you’re not. You have to find what works for you. But priority #1 is resolving the injury (injuries for you). So first you have to deal with the AT and PF injuries (videos on this SD site – check that out too). Now the question is – do you wear orthotics and/or oversupportive shoes while dealing with the injuries or will those only prolong them so you’re never going to fully heal? That’s a tough one and very hard to answer without knowing your exact situation. In my office, orthotics are gone the first day regardless how bad the injury is and then depending on the individual and their issues (injury and other lifestyle factors) I wean them out of their shoes towards more barefoot as quickly and as comfortably as possible.

      Sometimes people are just screwed up from years and years of compensations and although they change their diet and try to go barefoot and follow the free advice I have on this site, they don’t see any improvement. If you’re that person you just need to find the right doc or therapist who knows how to address the whole body to deal with these compensatory patterns so you can heal up.

  16. PhilipV says:

    Thank you for the prompt and thoughtful response. Regarding your final remark, do you know happen to know anyone in the Denver, Colorado area?

    Thank you also for recommending those other articles on your site. This is some very valuable information, particularly the article on sleep. I am making the transition to barefoot movement now, starting in my own home and in my neighborhood. The orthotics seemed to have been staving off the pain, but something about them did not sit well with me. It is just hard to believe that the human body would require such a recent and artificial technology in order to be healthy! And all the while, 99.9% of specialists issue the dire warning: “Going barefoot will ruin your arches and give you PF!” I hope the barefoot approach yields results. Already, I can feel that my gait is changing as a result of it, hopefully for the better. Cheers.

  17. I am a 34yr old male living 30miles south of Chicago, IL and I suffer from severe overpronation on my right foot. I was prescribed orthodics over two years ago and quit using about a year ago due to no relief or improvement. I wear steel toe work boots 8-10hr per day for work but other than that I am barefoot or in minimalist shoes as much as possible. I have tried stretches and exercises found on internet with no relief. I exercise minimum 3x’s/week and eat right. I am suffering from chronic lower back pain on left side, pain in right shin and general foot pain/aching in right foot. Any advice or recommendations would be greatly appreciated.

    Thank you

    • Well the pain in your foot is related to the overpronation, but as you know from reading the article that’s just a name and doesn’t mean anything important – it’s just a symptom of a most likely very weak tibialis posterior muscle from significant adrenal stress. Now you have compensated = left side lower back pain. So you need to find a doc or therapist (or come to NC to see Sock Doc) to fix you up. You can of course try to find some of the trigger points which may help – in both the Low Back Video and the Foot Pain Video – and dietary changes will help with inflammation – but you may get only so far because “severe” overpronation typically develops from a lot of compensations and results in even more and those all need to be worked through.

  18. Hey,
    been looking for some answer for my sever overpronation. Been documented that I’ve had it for about 5 years now when i started having knee problems, some patellar problems. to this day ive have several ankle sprains on both feet and that what just the beginning. last year things have accelerate when I stopped working out and playing soccer because of the muscle strains I would get from overcompensation and just bad biomechanics. Now I have some cartilage wear and tear in my knees,ankle popping,metatarsal pain, hip pain, heel pain, heel popping, PF, low back pain and grinding, shoulder pains and grinding and sternum pain/popping and rib pain, with elbow problems which may or may not be associated.
    I have been looking at this procedure hyprocure which advertises itself to be the all mighty cure however the fact of sticking something in my body that is not supposed to be there baffles my mind how its a fix. There must be a conservative cure for this, I’m close to trying this surgery though. I’ve been battling this at a young age I cant even work or do much because my limbs get fatigued and painful at all the lower limb joints. Is the tibialis posterior the one muscle weakness causing this, and how could I reverse overpronation. I feel like my gait needs to be retrained and strengthened but it seems impossible to do.
    Hope to hear back

    • As much as I’d like all the free info I have on this site and drgangemi.com to fix everybody, it will never happen. Sometimes you need to be examined and treated by a doctor who looks at your entire body and the inter-connections between all your injuries as well as the correlation between your health problems. That’s why I say a “knee expert is great at surgery for the knee – but not a true expert of the knee unless he/she knows how the ankle, hip, and even the shoulders affect the knee.” So if you can’t get to NC to see me, then try to find a doc or therapist who will look at more than just where your pain is – perhaps a chiropractor or other naturally minded physician, skilled massage therapist or rolfer, or even a physical therapist who has been trained beyond their conventional education.

  19. The thing is i’ve been to quite a few surgeons sports doctors and physios and they all are confused by my symptoms occurring at the same time and cannot come up with an answer. if their was an imbalance in my tibialis posterior and anterior would it cause my ankles to drop in when i put weight on them and could it be reversed? and if so how. thanks for the quick response. I didn’t mention I am a semi pro soccer player been injured for almost a year now.

  20. Site is wonderful-thank you for your time..I have switched more towards a minimal running program and where minimal shoes as much as possible. I was considered an “overpronator” I do, now, have lateral ankle issues (almost a bruised feeling on the anterior lateral portion of the ankle bone)-Is this from switching to a more minimal aproach? Any thoughts on what to do-or is RICE the only option here-the pain has been there for about a month.

    I also have an excessively tight psoas on the right side which has led to low back pain as well-I believe anyways.

    Any suggestions of a Doc down in Dallas?

    Thank you for your dedication.

  21. Enjoy reading your approach to the body. I have some comments / questions related to fixing the foot (and body) and cycling. Not sure how knowledgeable you are about cycling fitment and the body.

    Bike fitters who actually bother to approach the foot / shoe and pedal interface mostly use an array of custom or heat-moulded innersoles and wedges (inside the shoe in the front and/or rear and outside between shoe and pedal). All this is done to fix problems like knee pain, low back problems, etc. Bike fitting is a bit more complex with regard to the seat height and positioning of seat and handlebars but I am only referring to feet

    You can see were all this is going. Understandable that during cycling the foot is fixed to the pedal and therefore not as flexible in movement as with running. But somehow this does not seem right to me to give someone a crutch to fix a problem. This is similar to pro- and anti-pronation bars in shoes, high heels, orthotics, etc. seen in running shoes.

    In most cases proper alignment and balance of the left and right side of the body will fix these problems. If all the muscles are free-moving and in balance most people should be able to perform optimally and injury free. Would this approach seem correct?

    • I’m very familiar with bike fitting and I strongly recommend everyone who rides regularly have a bike fit by a professional – not just a computer analysis but a skilled bike fit tech.

      Your question/thought process is excellent and really one to be discussed in an-depth article. But I’ll share some thoughts based off my own experience and that with treating other cyclists.

      * One question comes down to how much is “wrong” structurally with the body that should be corrected via a bike fit (wedging/insoles/cleat position) or how much should be dealt with it in regards to actually correcting the body. So if you say, overpronate, do you just wedge the cleat or make an insole to “correct” the problem; or do you find why the foot is weak and fix it? Of course finding the cause is ideal as this will make the cyclist stronger, more stable, and more powerful. But – second question/point:

      * How much is the “fixed position” going to impact the cyclist? You’d think that correcting a foot that is in such a fixed position would not be as harmful to the athlete as doing so in a more dynamic manner (running). I had a bike fit guy in town, who is very good, give me the SOLE insoles because his philosophy is that the foot should be very snug in the shoe and even have the arch supported. I don’t agree with this – I think the arch should still be dynamic and allowed to naturally flex, at least to the extent that it should or can in a bike shoe. However I do think that a bike shoe should be much more snug than a running shoe – you want to be tight with the bike.

      Cycling is an un-natural movement. So I’m open to give some leeway when adjusting the bike to the body as long as it doesn’t create or support dysfunction. But ideally you want the body aligned and then the bike fit to that body. Unfortunately though many people have so many imbalances that they have the bike adjusted to their un-adjusted body.

      Anyway, those are some thoughts. I’d love to hear any experience you’ve had or knowledge out there.

  22. Hi,
    I am 5’4″, 120lb, 27 year-old female. Ever since I began walking, I have had a “duck walk” turnout and over pronation in my feet as a result. After playing sports when I was a child and teenager, I experienced swelling and a chronic ache in my left foot. After visits to orthopaedists and podiatrists before entering college, it was determined by X-Ray and MRI that I had a talocalcaneal coalition, or fusing of the talus and calcaneus bones of my foot. This coalition was something I had been born with and I have been told that had it been detected earlier, surgery would have been beneficial. As it stood then at 17 and now at 27, surgery would most likely result in scar tissue and perhaps even more immobility. I do have a prescription orthotic but find that when I buy new shoes (usually Brooks Adrenaline GTS or Nike Pegasus for trail running), the orthotic is overkill. I usually know when I need a new pair of sneakers (6-8 mos) because my foot pain increases drastically.
    Lately, I have been working out daily in a new pair of sneakers without the orthotic and with little issue. My workout routine consists of weight lifting and the elliptical but I try to switch to running as it gives me the best results physically, yet I have found that is when my greatest pain shows with or without the orthotic. I am able to run for 3-4 miles a day when I start but after a couple of days, I cannot run five minutes without an ache in the lateral posterior area of my right knee, the opposite side of the foot with the coalition. My knee feels stiff as if I have over extended it and it is painful to even raise it to begin a steady gait. I can hop on the elliptical with no problem immediately following, so what is the issue? Should I continue working out without the orthotic? Am I destined to never truly get into running daily? Thank you!

    • Hi Loren, this is a tough one to comment on because I’d have to actually see what muscles you are shutting off when you run – and why. In other words, how is you body compensating from the fused foot to the opposite knee. I’ve seen a couple patients with fusing and both came to me with orthotics (actually one recently who had her cuneiforms all fused for 40+ years) and both are practically pain-free without orthotics. So I can say with certainty that fused bones doesn’t necessarily mean you need orthotics, especially if you developed that way. If you feel better without out then don’t use it but if you feel better with it then you’ll need to figure out the pattern of dysfunction before you can be orthotic-free.

  23. Scott W. says:

    First, I must say that I am skeptical about most of the things you’ve wrote, but I’m open to it. About 6 years ago, during my senior year of college, I “developed” flat feet. (Almost) Needless to say, I could no longer walk the 1/2 mile from my grandmother’s place to college without pausing in excruciating pain as my legs and feet erupt in pain (shin splints, plantar fasciatis, over-tight calves/hamstrings). Mind you, this is in the middle of NYC. Nearly everything written here flies in the face of everything I’ve been told by 3 podiatrists and a 2 teams of physical therapists. I spent nearly 2 years in PT to fix nearly every muscle group, either a result of finding my 2 herniated discs (cervical and lumbar) or fixing pain from fibromylagia (diagnosed by one doctor, debunked by another, I don’t believe I have it, but am usually tired and have muscle pain). Through several pairs of custom orthotics, and a couple of OTC ones, not much has improved. Still get shin splints if I walk fast (gotta catch that bus!) or if I walk for an appreciable amount of time (maybe 5-10 min?). I generally wear running or walking shoes (usually motion-control) with my custom orthotics, but improvements have only gone so far.

    Elsewhere I have found some concurring opinions, but the memory of pain-induced “statue-stance” (i.e. it hurts too much to move at all) haunt me and deter my resolve to walk barefoot. Others have noted muscle imbalances higher up the body, excitotoxins (aspartame and monosodium glutamate specifically) and visceral response from organs as a possible cause of flat feet (I usually have irritable bowel syndrome). I can certainly say that things seem to have gotten worse after drinking more and more diet sodas, having greatly increased my consumption since high school. I plan to eliminate them as soon as possible. Being American-Chinese, taking out MSG will be difficult, since naturally occurring MSG is present in a lot of stuff I eat and/or cook with, although I don’t go after food artificially laced with MSG (other than the usual dinner/feast with my grandparents in chinatown).

    I stumbled onto this site while researching sports orthotics, something I’ve never owned, but the promise of being able to walk around the house barefoot, or stand in the shower barefoot, without pain is too tempting. I want to be able to wear any shoes and go anywhere. Right now I mostly weight train, with light aerobics for warm ups. Any advice is surely and greatly appreciated.

    • Start at the “Start Here” articles in the upper right corner of the home page. Obviously you’re very unhealthy and have a lot of work to do. I hope this site helps you out.

  24. Linda Wiese says:

    Hi Dr Steve

    I am having trouble deciding whether I over-or-under pronate and I’m hoping that you can help. Years ago I was told by a podiatrist that I over-pronate and I was given orthotics. Running with the orthotics was agony so I stopped using them. I tend to buy shoes that feel comfortable but this time round, being older and with developing knee pain, I thought I should work out what my feet are doing before I replace my current runners.

    My arch is normal. I wear down the outer heel edge of all shoes that I wear. I do catch myself at times rocking on the outside edges of my feet. So far, everything suggests over-pronation. I’ve now checked the wear on my favourite runners and all the outer edge from toe to heel is worn – a sign of under-pronation I think! Any clue about what I’m doing would be most appreciated.

    • Ultimately it doesn’t really matter if you’re over or under – it’s just a name – you have a “foot imbalance”. But when you wear the outer heel more and you rock to the outside of the foot that is a weakness of the tibialis posterior and you are overpronating. More on that foot issue here: http://sock-doc.com/2012/05/foot-injuries/

  25. Over the moon having found your web site today. I’m going bare foot but need to find a “Sock Doc.” here in the U.K. It all seems to fit with my problem of not being able to rotate on to the front of my foot. My toes just scrunch up. I do have Parkinson’s which obviously doesn’t help and I seem to have had the lot as described by your correspondants. Do you know of anyone here in the UK that I can consult.

  26. Doc,

    Can you point to me to just one research paper that implicates cortisol and aldosterone as the cause of excessive foot pronation?

    • I’ve never looked for one. It’s a viscerosomatic relationship that you can find in applied kinesiology books/manuals (the link between those hormones and the muscle of the tib posterior). So, based off the way you worded your question, you will probably think it’s bogus since it hasn’t been properly researched.

  27. Hi,

    I am also from the UK, i’ve had bad knees and ankles for my whole life, dislocated my right knee 3 x and also my shoulder twice, I also have a small bunion on my right foot and a larger one on my left. I am currently wearing custom orthotics because if i don’t my ankles and knees feel very unstable and i get worried my knee is going to dislocate again. My dad also has bad ankles so could this be horeditory?

    What would you suggest I should do? I have also been looking and found the surgery someone was talking about earlier but i would like to correct everything naturally if possible. i am worried that this is going to get worse and worse if not treated and it scares me as i have trouble walking very far and running…i’m only 34 years old.

    • The best general advice I can give you is to read the articles in the Start box in the upper right of the home page – especially ‘Healthy People = Barefoot People’ and ‘Are Orthotics Really Ever Necessary?’.

      And no this stuff isn’t heredity.

  28. I have literally just bought a pair of shoes from Vivo Barefoot in Covent Garden, my feet were very happy in them in the shop, couldn’t quite get myself to buy the flip flop ones as they look quite odd but i’ll see how i go with the pair i got. how long does it generally take for the over pronation and other problems to get better after going down the barefoot route?

  29. I have always had a liberal patella (it has popped in and out my whole life) recently I had my patella pop out and not pop back in. I called an ambulance (as I was alone) 1 hour later they still hadn’t come so I had my phone on me and I looked up how to pop my patella back in (on utube) and I did it at home. I saw my first physical therapist a few days later. Who taped up my knee and then told me I needed orthodics. Order all new shoes and after wearing them for the first day now both my knees hurt, my shins hurt and most of all my heels hurt! Unlike your picture above I am quite the opposite. I have very high arches, my feet point out like a V, and the big toe part of all my shoes are worn out while the rest of the shoe looks untouched- my q’s are (1) what can be done so that my knee doesn’t pop out any more (2) what are these orthodics for? (3) what can I do about my duck walk?

  30. Hello doctor, I thank you for all the useful information and have started practicing the right steps to cure the problem. I have a question, I have flat feet and over pronation, pain in the archilles tendon and heel. I do not over exert these. But could you plz tell me that by walking barefeet,stimulating trigger points, eating healthy, can the allignment of my feet be corrected ( Higher arch and normal pronation) or will it only lead to strengthning of the muscles and foot so they can support better and get rid of pain. In the sense will it heal the root of the problem or only provide means to live with flat feet. Thankyou

    • Please read the articles in the “Start Here” in the upper right corner of the home page – specifically the one on Trigger Points and Orthotics as they will answer your questions. There is no correlation to flat feet and you pain, as you will learn.

  31. Hello,
    I am hoping you can help answer some of my questions. I have a collapsed ankle (overpronation) and a flat foot on my left side and a low arched fairly stable foot on the right. I am not sure if this is related, but my left leg appears to be longer. It is noticeable enough that you can see that my knees don’t match up directly. I have always walked like a duck with my feet out to the point that caused kneed problems and MANY broken toes from smashing into furniture (my brain expects my toes to be in line with my heels I guess). I have recently taken up bare-footing (about 3 weeks in) and found that my feet are getting wider and thicker but I have also experienced hip joint pain on the right side and and ankle pain on the left (collapsed) foot. ( Note that this pain was before the bare-footing but I was hoping it would go away when I started.) I still take a 3 mile run every other day in my stability shoes because I do not think I can transition yet. I was wondering if I should consciously try and correct the duck feet to walk straighter? And should I also try and lift the fallen ankle somehow? I would appreciate a response if you can manage. :) Thanks so much!
    MJ
    Whoops! Reading over my post (above), the RIGHT leg (with the hip pain) is longer not the left.

  32. Hi
    The soles of my shoe tell me that i am over pronating.(I wear running shoes with great support and cheap runner with little), Last year i had to give up cross country running because about 5 minutes into a run (no matter how much i stretched) my calf muscles would become extremely tight and it became difficult and sore to run. I was wondering would my over pronation be causing this? I also suffer from slight knee pain and shin pain plus recently when i walk i get a stiffness in the underside of my arch when i am pushing off the foot but the main problem was with my calves which i thought would go away with time.
    My shoe has a lot wear on the inside at the top of the shoe and wear at the mid and rear outside of the shoe.
    Any help much appreciated.

    • Remember overpronation is a symptom, not a cause. Tight calves – think of your nervous system being in overdrive. That means too much stress – training too hard – bad diet – etc…

  33. lisa scimeca says:

    Hello,
    I am 45 years old and I am a hairdresser, so I am standing in one spot for hours. I started do zumba about 4 years ago. I started to notice some knee pain here and there, then it turned into foot/heal pain. After a year it got so bad a couldn’t even put my heals on the ground without screaming pain. I went to the doctors and was told I had Plantar Faciatis I have been dealing with this for 2 years now. I have watched your video and I do message my calves but as soon as I start working out again or working alot the pain comes right back and the tightness in my feet come back. Do you have any suggestions as to what I need to do.
    Thank you so much
    Lisa

  34. I have been running for a few years in my Nike Free’s without any issues then gradually noticed achilles tendon getting worse. My Podiatrist has given me orthotics and told me to get a more stable cushioned running also. The cause of the over pronation is a quite a big “bowing” effect in my lower legs. Am I resigned to running in orthotics now? Also, should i put my orthotics into an “over prontation” running shoe or just into a normal lighter running shoe.

    • Please read the orthotics post(s); you will know where I think orthotics belong. Ask your podiatrist how they will correct your overpronation. The answer can only be hilarious since they will never correct it. They will however, support your problem, make your feet weaker, and result in lifelong injuries and gait imbalances.

  35. Hello Soc Doc I really like what I am reading on your article! First time commenting to get more “personal” info for myself. Anyways I am in the Army, so running has become a part of my life so to speak. I overpronate when I run, but only get shinsplints when I do a lot of miles a week or run everyday… (I usually run every other day to avoid injuries)..

    I recently purchased Brooks Pure Cadences and while they are comfy just for wearing, when I run two miles or more I notice that my calves/achillies tendon get tighter or even lockup mid run… This usually goes away after a 10 minute stretch… I usually wear shoes that help out my flat footedness, but recently decided to run minimal. I have a heel to toe stride, so this mid foot or toe running is a bit new to me. My main question is, when my leg locks up from this running with the PureCadences, should I take it as a workout (I.e. this is a normal reaction to a new type of running and it will get better with time) or should I get worried and drop the shoe and go back to what I’m used too?

    Sorry for the long question and thank you for your reply!

    • I get lots of questions from military guys, great to see and thank you.

      Those shoes are a 22-17mm stack height which is pretty thick, though only a 5mm drop which is not too bad. But your calves should never lock up on you, regardless of how flat your foot is (and you don’t need any arch support for flat feet). So you should not take it as a workout – you should try a different pair of shoes and evaluate your training to make sure you’re aerobic as I note in the Sock Doc Training Principles. You say “go back to what you’re used to” but I hope that doesn’t mean a shoe with even more support. I think you might like the New Balance Minimus Trail shoes – not the new zero-drop MT00 but the MT10 which is a 15mm-11mm stack and much more firm than the Brooks you’re wearing. Good for trails too.

  36. judith pitt says:

    Hi
    I have inter digital (Mortons) neuroma on my right foot and my orthotist has given me arch support orthotics for daily wear even though I have a normal gait as far as I can tell. I have also had steroid injections to no avail. I wonder what sort of running shoes I should use.
    If I use stability shoes which would give me similar support to the orthotics that would conflict with the fact that I have “normal” feet shape and would they cause more damage?? Surprisingly running causes less pain than standing and walking and I’m a Nurse so I do a LOT of that! Currently wearing Asics 2160.
    Thankyou

      • Hi Sock Doc, I am a 50 y.o. woman. I came upon your site not long ago within days of receiving my orthotic inserts. Then I took them out and have not used them since! I have not read about trigger points yet, but so much I’ve read from you makes sense. I had been hoping to find correlations between my problems, and now I think I have. But to back up, here is what I have been dealing with:

        At age: Newborn, minor hip misalignment. At 20, minor knee pain when jogging; knees have been clicking. At 24, neck/shoulder tension. At 27, rocking feet outward when standing. At 29, stressful marriage begins. At 32, diagnosed with depression and started on antidepressant. Have been off & on medications since then.
        At 45, occasional debilitating lower back pain from yard work, bending wrong; begin chiropractic and deep tissue massage. X-rays show a significant forward position of neck curve. At 49, fully enter menopause. “tennis elbow” from strenuous gardening. At 50, knees hurt a little from lunges & squat exercises? Begin foot arch pain; diagnosed with patellar-femoral sydrome; overpronation, plantar fasciitis, flat feet, and bunionettes; prescribed orthotic inserts.

        Even more recently after finding you, I’ve read that menopause allows certain deficiencies, for example adrenal, to come to light, which could explain the injuries I’ve had since menopause.
        Here’s what I have done based on yours and other articles I’ve found: switched to Merrell barefoot shoes and NB Minimus for walking, also walking and rebounding barefoot, cleaning up my diet, looking into adrenal and pregnenolone supplementation, and looking for a doctor who can help me.

        My questions: 1. What do you think about the supplements I’m considering, and testing for hormone levels?
        2. Are the stretches and strengthening from traditional therapies helpful for tennis elbow and patellar-femoral syndrome (quads exercises), and neck pain? 3. Can I correct my forward neck position? (and dowager’s hump forming) 4. Is rebounding on a good (soft) rebounder OK for my knees and feet? 5. Is it possible to do squats and lunges safely for my knees?

        I guess you no longer make referrals, but I live near Indianapolis. There should be somebody here who can help me…? Thank you so much!

        • Sorry – this one is too specific to give answers to. I cannot comment on your supplements since you’re not a patient of mine. I never recommend stretching. Never.

          • OK, thanks.
            Can I ask you what you would advise to normalize a forward head carriage/forward cervical curve and for the pain and stiffness, if not stretches? Or is this diet/stress/adrenal-related as well?

          • That’s hard to say because it’s so individualized. It could be from an old injury to your neck or other area of your body/spine. It could be from poor footwear over the years (common in women often wearing narrow, high-heels). And yes it could be from any hormonal stress or nutrient imbalance. Stretching will never, ever, “loosen” up tight muscles. And I mean never-ever. :)

      • Hi
        Thanks for that but already looked at those sites. Just need to know if I’m causing more damage by using the orthotics and if I should really be wearing stability shoes for running. So much conflicting advice out there but yours seems more “common sense” than most.
        Thanks

        • I cannot personally advise you what to do. As you know, I am pretty much 100% against orthotics and anything that alters foot function – “stability shoes”, for all the common-sense, as well as physiological reasons you’ve read throughout this site. Ultimately, you need to do what is best for you, and what makes the most sense for you! :)

  37. Sock Dock

    I believe for a long while I overcompensated with my left foot, now I recantly put in a heel gell ,when I stepped down, there was this …idk relief through the whole left side of the body, could it be possible that this tightened /tensed up other parts of the body due to compensating on the left side ? If so how do you normalize after a long period of time?
    Best
    Mike

  38. Soc doc
    Thanks for the response.
    I have relised only latley,that I’m stepping down harder on the left heel of my foot, when I tried putting in one of those gels . Imidiatly I felt relief,not only on the heel. But the left side and upper body felt somewhat more relaxed ,shoulder arm , left side of abs etc, My question is, could steping on one foot harder throw off one side of the body more ? If this is the case how do I go about normalizing it so to speak, it feels like it needs some sort of pressure when I step off the heel gel things go back to the way it was,
    You’re thoughts much appreciated

    • Anything imbalance in the foot can affect the entire body – shoulder, back, neck, etc. You might look for a good massage therapist, rolfer, PT, or chiropractic doc.

  39. I Recently went to the podiatrist and the podiatrist said that my feet needed orthotics because at the end of the day the muscles at the back of my leg hurt, my feet pronate and they are flat. She said they would take 2 weeks and to help the pain in my legs and feet I would need to strap my feet with tape. She’s done it and showed me how to do it but I was wondering what this sort of strapping was called?

  40. You’re the man Doc. Been checking you out for a long time and totally dig that you are on Trail Runner Nation now! Noticed everyone else posting and thought i’d give it a go to see if you’d reply!

    I’ve been a ‘mostly’ barefooter for ~7 years, ‘transitioned’ into minimalist shoes last year from a barefoot 6 months/shod 6 months lifestyle. Unfortunately I developed a chronic case of post-tibial tendonitis last year, approximately 3 weeks prior to my first 50k..I assumed it was purely overtraining/chronic stress (member of the Ocean City Beach Patrol, beach competitor, tri-athlete, distance runner, sprinter, swimmer, paddler, high stress job…) but here I be, a year later, still wondering why the heck i’m not healing.

    Tried healing myself through time off, strengthening, band/resistance rotations on the ankles and then broke down and hit up the physical therapist and doctor – who were bogus. I refused to go in for their orthotics and padded shoes. Anyways, I desperately want to be back up into higher mileage, and i’m desperate for a running doc!

    That’s all beside the point, not looking for an answer or cure from you, just curious if you have a recommendation for a doc in the DC area? I checked out this guy Dr. Pribut, but he is a podiatrist and I guess I’m looking for more of a holistic approach where my entire body is evaluated, because I am assuming this is a matter of over-compensation on the left side of my body since I have had ITBS and peroneal tendonitis on the same leg over the past 2 years.

    Even if you don’t have anything for me, cheers, and keep up the good work!

    • Hi Aaron, thanks for the comment. I don’t refer too much anymore as it’s backfired too often – docs prescribing orthtics and other bogus therapies.
      You’re only 4 hours from my office. Give us a call and get on my wait-list. If you’re still in pain in 5-6 months, I’ll help you out.
      But right, after being injured for so long you develop compensations upon compensations and those need to be “unraveled”.

  41. Rebecca Williams says:

    Dear Sock Doc,

    I’m hoping you can give me some advice. I’ve had some long-term issues. First of all, I’m hyper mobile. When I was 16, I developed pain in my knees when walking. The orthopedist said my knee caps didn’t go straight up and down on flexing, but up and outwards. When I was 18, I severely rolled my right ankle and the force was such that the muscle came off the bone along the outer edge of my foot and fractured the bone. It healed but I continued to roll my foot and sprain my ankle frequently, just walking down stairs or over uneven pavement.

    Fast forward to 2000 when I was 28. Within the course of a year, I developed plantar fascitis (sp) in my left foot following a day walking around in sandals (I did change my gait as I developed several blisters), sciatica-type pain in my left hip/buttock, back spasms and pain in my mid back, and pain in my right shoulder (which seemed to be caused by computer work and cardio kickboxing). I saw my GP (sciatica – who simply told me to work standing up), an orthopedist, and a podiatrist. None really helped me much. Only after a few years did my plantar fascitis get better, and the back pain stayed away as long as I exercised regularly. My sciatic pain and shoulder discomfort never went away.

    I started seeing a chiropractor just over two years ago. I was diagnosed with a degenerated disc (L5?) just above my pelvis and another one in my cervical spine. A year+ ago, my chiropractor (on my insistence that he investigate more thoroughly), he discovered that my left illium is rotated upward and forward, and the left side of my sacrum is sticking out. My sciatica is much better, but it’s not gone. However, it seems to get worse if I do exercise. 1.5 years ago my right big toe started to hurt horrendously. The sports podiatrist diagnosed a functional limitation in my big toe. My x-ray was fine. They gave me orthotics and the right one was highly angled on the arch, tipping my foot out (supinated?) to encourage proper movement in my toe joint. Unfortunately, the orthotics led to severe, burning pain in my right ankle following jogging. So they adjusted the orthotics by adding a wedge to the outer area of the orthotics just below my little toes.

    I still have my toe and ankle discomfort. Tight toe box shoes make my toe feel worse. My arches are on the high side of normal. I bought some Vivobarefoot shoes last March and I’ve been wearing them almost exclusively since then. I also wear them during Zumba classes and when I try to jog (it doesn’t work that well yet). I do cross training exercise at home barefoot. And my feet are stronger. I’ve also just discovered that I have Morton’s toe (both feet). I also have noticed that, when standing, my right toe seems to be slightly elevated. I’ve also noticed that, when I stand, my feet point outwards a little bit. When I walk, my left foot seems to move normally (land in the middle then pronate in for pushoff), but my right heel seems to land on the outside, then goes up the middle part of my upper foot, and then rolls outward to push off with my outer toes. (I also did the test where I point my toes down and rotate my foot inwards. The arches in both feet hurt a little bit – my right arch much more so.)

    I’m sick of seeing doctors and other specialists who treat the symptoms and don’t fix my problems. Do you have any suggestions on any exercises I can do or what else I should investigate?

    • Hey Rebecca – yeah you have been through the gamut as many have. And now you’ve developed compensations upon compensations and layers upon layers. So you’re a mess. Sorry to hear that. Looks like you live in Scotland (?) – that’s a ways away from me. Maybe you have a good bodywork therapist there (like a rolfer), or a doc who looks at the entire body. Typically when you get into it this deep as you are there isn’t just one point to treat or one thing to change – it’s a huge unraveling process.

      • Rebecca Williams says:

        Thank you for your response. I will see what I can find here. Scotland is much more limited than the States in terms of everything. We’re planning to move to southern California in the next couple years and plan to swing by and visit my folks in Wake Forest. I’ll be sure to book a few appointments with you while I’m there!

  42. Sock Doc,
    Do you ever see patello-femoral syndrome/improper kneecap tracking as a result of over pronation? Or do you commonly see it as a result of something else?

    Also, is a cardio workout best by itself? More specifically, is it stressful on the body to do some of the exercise programs that combine weights and cardio, or lunges/squats along with cardio? They’re supposed to be time-saving, but can these workouts be harmful?

    Thank you!

    • Sure I see that but it’s all related. Someone with a knee issue often has a pronation/supination problem but that doesn’t necessarily mean that one is causing the other – they could both be there as a result of any problem.

      The answer to your second question all depends on your current fitness level and what you’re trying to achieve. Read the SD Training Principles. I’m all for combining them during certain workouts, but not all, and it is all individualized.

  43. I am confused by your description of overpronation. My experience, and other descriptions I have read on the web, indicate that overpronators will wear down the inner shoe bottom faster, such that empty worn shoes placed on the ground together will lean slightly towards each other. Yet you describe and show pictures of disproportionate wear on the *outside* of the shoe. Can you please clarify this? If my foot strikes on the inside edge and my ankle is rolling in, why would the outside of the shoe wear faster?

    • True “overpronators” strike hard on the outside heal of the shoe and then excessively roll inward. So you see the outside heel wear pattern and then the shoes leaning inward as you describe.

  44. Dear Sock Doc,

    I have only recently come to learn of different gaits (underpronation, neutral, overpronation) after visiting an orthopedist for knee discomfort and lower back pain. I’ve had discomfort in my left knee for several years but every doctor I’ve seen told me to strengthen my quads. The lower back pain is relatively new. When I told him about my knee and lower back, he said it’s because I’m an overpronator. So he told me to try stability shoes (with a firm heel and only bends at the forefoot) for a month and see if that helps.

    The thing is, I have bow legs, high archs, and as I recently discovered I overpronate. Are stability shoes (I got the Asics Kayano 17) what I need? Before those I had neutral cushioned shoes (Nike Vomero 7) which were very comfortable, but not sure if they’re right for overpronation. At least, that’s not what I read anyway. I wanted to know what shoes would be best for my combination of bow legs, high archs, and overpronation for exercising.

  45. Hello doctor,
    The exercises and suggestions that you have given have really helped. I would also want to know whether Nike +3 free run shoes good for running? The company suggests that they are designed for barefeet running. Or would you suggest any another brand/model. Nike, puma, adidas and reebok are available in the local markets.

    Thanks
    Shantanu

    • The Nike Free 3.0 model is a frequent shoe that I advise my patients to wear to transition out of a conventional shoe. It’s a transitional shoe – not a barefoot-style shoe.

  46. My son had bilateral tarsal navicular stress fractures. Countless surgeons, doctors and physical therapist have prescribed countless orthotics. He has remained constant that he feels the best barefoot. He is about to start his basketball season. Do you have a suggestion for a basketball shoe? ANY suggestions or info related to his injuries would be greatly appreciated.

  47. Albert Ferrell says:

    I am in my 70’s with a rigid cavus foot and find a low arch support feels good. When I do off road walking without support my knee’s get very sore. Am I stuck or what?

    • Impossible to say but from my experience I’d say highly unlikely. It all depends on what is causing it. Clearly there’s some imbalances and you need external support. If the many topics I address on this site don’t help you (diet, trigger points to check, injury prevention, etc) then you should look for a doc or therapist who can properly assess you can help you figure it all out.

  48. Julia Spear says:

    Over a month ago I sprained my ankle. It wasn’t a bad sprain. I was able to walk with some swelling and discomfort. It’s still swollen a little bit. When I point my toes down as far as I can and turn it like you said, there is pain where the ankle is sprained and a little swollen. I have noticed these past two weeks that my shoe is looking strange and to the side.

    I don’t know what to do. Is there a possibility that when my foot is fully healed it will go back to normal? If not, what should I do? Thank you, I am panicking a little.

  49. Hello Doctor.

    I was diagnosed 6 years ago with low back pain as a result of herniated L5S1 disc. Over the 6 years, I’ve had about 1-2 flare-ups per year, which I manage with meds and strength building physical therapy.
    This last episode has resulted in more pain in my left buttock, with pain (sciatic) down my left leg. The sciatic pain has diminished, but am left with a pain in the piriformis muscle, which leads me to think I may have piriformis syndrome. So I’m not sure if the disc issue is related; but my PT has noticed an inflamed piriformis muscle and has worked on that with stretching and massage.
    During my research, I found your website, and am now unsure if the piriformis issue is related to disc injury, or poor muscle imbalance. I have looked at the wear on my shoes but don’t notice any signs of overpronation; but my ankles do bend inward at the Achilles tendon as you photos show. Do you think they are related? and that may be the cause of my pain in and around the piriformis muscle? I also was told by my back doctor that I have bursitis in my left hip… another coincidence?
    I have a friend at work who is a foot minimalist. He wears converse knock-offs and swears by them.
    I realize I’ve thrown a great deal of info your way, but do you have any thoughts and recommendations?

    thanks,
    Paul

  50. Hi Doc,

    My acupuncturist recently told me I’m an over pronater based on seeing calluses on my big toes and balls of my feet. (And of course referred me to someone for orthotics which I’m not going to do.) When I look at my shoe wear pattern, it seems pretty even to me. My feet are wide except with a narrow heels and very high arches. I went barefoot as much as possible as a kid and have been wearing minimalist footwear for the past two years or so with no pain. My question is if these calluses are a problem that I should be looking into?

    Thanks for your amazing web site!

    • Callouses aren’t normal if they remain (that’s too much isolated friction) – but if it’s just thick skin then that’s usually normal.

  51. Will Caplenor says:

    Hi Sock Doc,

    I have as what seems to me from doing some research a fairly unique running problem. I run around 20 miles a week and have done so for a year and a half or so but have always had a problem with my right achilles. I don’t overprontate, have very pronounced arches, and run on the balls of my feet (maybe to my detriment as my heels don’t naturally touch the ground during my normal gait.) I use minimalist shoes and try to be barefoot as much as possible. I recently retired my last pair of shoes and on the soles of both shoes, towards the outside of the shoes, they were incredibly worn. Particularly on the right shoe (the side I have achilles problems). They were in fact so worn out that the rubber area of the sole was completely worn through to the much softer underneath. Your advice on this matter would be greatly appreciated.

    I shoud probably clarify and say that the worn areas of the sole are at the balls of my feet to the outside, not at the outside heels like you described and overpronation to look like.

    • This could actually be an underpronation problem, as you’re not naturally pronating inward over the big toe. Check out the Foot Pain Video and the Achilles Tendonitis Video, both on this site.

  52. Troubled feet says:

    Hi Sock Doc,

    My ankles are swollen after running only 13k per week for several weeks. I believe this is the result of me over-pronating while running. I looked at my legs and it seems the bones are not straightly aligned. Would that be a structural problem that cannot be remediated (i.e. i have to quit running) or can exercises or Orthotics could help?

    Appreciate your thoughts.

    Thanks.

    • Orthotics never help. Please read the articles in the upper right “start here” box for more on where to look next for some help to your problem.

  53. I am i girl with pronating feet. The pronation is small, but I still need help because i dance. What can I do? Can you help me?

    Thank you, Elizabeth

  54. I’m glad I found your website. I’ll definitely read more later, but I’m tired at the moment. I have low arches, and the sales people at my local running shoe store recommend me motion control shoes based on how I run. At least two sales people have recommended me motion control shoes. I don’t think I ever I had PF in my right food until after I wore these types of shoes for a few years. A coincidence perhaps I don’t know. Pain is in my right foot along the arch. Someone told me too much support can be bad, so I ended up recently getting some replacement insoles, not orthotics. I suppose this is okay? Should I avoid motion control shoes in the future? If so, what should I opt for? I’ve been jogging once a week, taking it slow. At work, I’m on concrete quite a bit, and that’s when the PF flares up. Sometimes when I run I get pain near my inner thigh/groin area, maybe the hip abductors? Another thing I noticed is that the tread wear on my shoes is at the outer upper portion. This is not typical of an overpronator, so what does that mean? I never have knee pain or shin splints, but I do in the ankle pain sometimes.

    I saw a physical therapist a year ago. He told me I had short/stiff hamstrings, more stiff in the lateral area than the medial, short TFL/ITB, short external hip rotators, and long internal hip rotators. I cycle a lot and am trying to get back into jogging.

  55. I watched the PF vid. There’s definitely a tender spot along the inside of my tibia bone and on the upper outer part of my calf and around the lower calf area. I did jog yesterday though. My jogs are very slow and easy. I don’t even get into HR zone 3 when jogging. I’ve taken a VO2max test, so I know my AT and LT points. I’ve scored a 63—I’m not unfit at least for cardio anyway. My feet apparently are.

    My diet is pretty good since August. I avoid seed oils, sugar/HFCS, cerial grains, etc. Before that, it wasn’t the best. Diet is a variable I can eliminate and who knows perhaps it improved my PF. My arch pain is much better now than what it was months ago, but maybe that’s partly because of the newer shoes. Anyway I work at a warehouse which has a thick concrete floor. This and wearing my old worn out motion control shoes caused pain along my arches pretty badly. I wonder if wearing old worn out MC toughened up my feet or made matters worse? I was thinking of a getting a minimalist running shoe, but I wonder if it would be okay for concrete. I do have a newer MC shoe I use at work for about a month or so and another MC shoe for running, but perhaps I should stop using these. I used to be able to run a mile in under 6min when I was 12, but now I feel like a cripple.

    What about my unusual tread wear? What in the world does that mean? I thought I was a supinator until I saw these sales(wo)men. I even told one of the salesman, and he said he had no idea why my tread wear was like that and that I was an overpronator.

    As you suggested, I started to walk barefoot in my home, but when I do that now I’m walking on my toes. I was wondering is this okay walking on the toes.

    • I would not be so concerned about your wear pattern. Once your gait is normal and your feet are strong the foot will pronate & supinate correctly – of course that also means no motion control shoes.

      If your feet are healthy (or once they are) you can essentially be barefoot on concrete all day long with no problems; so find shoes that protect your feet per your work situation.

      Not sure why you’re walking on your toes unless it’s because your body is used to some pain pattern.

      Read this if you haven’t yet: http://sock-doc.com/2012/04/lose-your-shoes/

      • I don’t know why I’m walking on my toes either just a habit, and I read that article yesterday. I bought a pair of Minimus Trail earlier today. They were on clearance. I seem to walk and jog in them okay at the store. I’m landing mid-fore foot. I tried a couple others with a 4mm drop, but I didn’t like how they felt. The salesman stressed a gazillion times that they’re risky. He even said that they never specifically recommend people those kinds of shoes unless they specifically ask for them. He said these types of shoes don’t last as long and to increase cadence/decrease stride distance.

        My only other question is would you recommend them while cycling? I use Power Grips on my pedals. My right foot felt a bit odd while riding. Since these shoes are far less bulky than the motion control ones, I could tighten up the straps. My right foot is bigger, too. Taking out the sock felt better. I could get thin socks. I now recall that my right foot felt a bit odd when I got new motion control shoes while pedaling, too. I’m now wondering if this messed up my foot in any way with the excess cushioning. I would have to cycle a few more times I guess and tighten the straps to see if the issue goes away.

        • Don’t listen to that salesperson; doesn’t know what he’s talking about.

          Cycling shoes are a bit different – you’re in a fixed position with the bike, so you need cycling shoes more snug, but you don’t want arch supports in there to alter foot function.

          • Do you think it’s fine cycling with a minimalist running shoe? I’d like to get cycling specific shoes, but then I’d have to get new pedals, cleats, etc. = more money down the drain. I need a new wheelset first and would rather not have to go that route with cycling shoes just yet anyway. By chance, do you have any recommendations, or does it really matter since we’re not even walking/running in them? I know a lot of guys like the Speedplay pedals.

            The salesman did say that he tried them, and that he benefited them, but he kept rambling on about how risky they are, and it kinda seemed like he didn’t want to sell them lol. He did mention that people have tried them and just returned them back pretty quickly. I guess these types didn’t take the necessary precautions. He did tell me that they’re coming out with a new minimalist shoe that has a removable sockliner where you adjust the drop from 4mm to 0.

          • Sure you can do that but ideally you should be using a cleat-pedal system.

  56. The outer parts of my ankles are a bit sore the following day. You know what this is? Moving my feet inward, I can feel something in front of the lateral malleolus (?), the huge protruding-like thing on the outside. Moving my feet outward, I can feel it behind the big protruding thing. What’s this about? Thanks.

  57. I definitely overpronate, but everything I find about what sort of shoe I need seems to fall in one of two camps: I need a stability/motion control shoe (not sure what the difference is) or that there’s actually very little scientific support for needing such a shoe. My own anecdotal evidence and injury experience obviously isn’t a sufficient sample size, so wondering if there is any authority on the subject or “general consensus” – is this all a ruse by the shoe companies? From http://www.runblogger.com/2012/07/tread-lightly-interview-on-runners.html:

    “I came to find that there really isn’t a whole lot of good science supporting the whole paradigm that we should fit people based on how much they pronate. [Then] you get to talking to people like Jay Dicharry (who runs the SPEED Lab at the University of Virginia) and you find that arch height is pretty meaningless when it comes to fitting shoes because what the arch does when you run is very different than what it does when you stand.”

    On the other hand, lots of other sources seem to advocate specialty shoes for runners who overpronate (http://overpronatorshoes.com/choosing-a-shoe):

    “For severe overpronators, a firm shoe with high motion control is a must.”

    • No overpronation device or shoe will help correct your foot problem. They will support your problem & promote your foot weakness & dysfunction.

  58. Me again. So how long is this going to take to reverse the process so my feet, legs, or whatever get better and the PF goes away? I’ve been walking barefoot at home and wearing minimalist shoes for two weeks. I’m not expecting it to get better overnight but really how long is this going to take? Right now I’m feeling tight in the hamstrings and PF is creeping up again in the right foot. Calves feel fine as far as I know.

    • That’s impossible for me to say. I can’t offer you personal advice via the internet so of course there are no guarantees that the info/videos I have here regarding PF will help you. Hopefully they will. As I note in the Trigger Point Article, trigger points are there for a reason – so if your PF is a result of something much more involved (stress of some sort) then treating the points won’t help much or at all.

  59. Hello Sock Doc. I thank you for your information. I wanted to know what you would suggest to help correct my foot problem. I have read some of your information speaking about pronation and supination. What I have understood from the information is that much of the discomfort that people have in their legs is due to the they overstressing of their muscles,etc, and so you suggest for them to use minimalistic footwear and/or walk barefoot as much as possible. For me, my problem is different. As far as I can remember I have never felt pain or discomfort in my legs because of the way my feet are, Thank God, except for of course a sports injury or such things like that. Likewise as far as I can remember I have worn out my heel, particularly the outside part of my heel. So how can I prevent or reduce the likelihood of wearing out the outside heel of my shoe?
    Thank you very much, I look forward to your response.

    • So you’re saying you have no pain/discomfort but you’re concerned about the excessive wear patter on the outside of your heel? If that’s the case then there is probably some foot imbalance and I’d recommend you see if there are trigger points in your lower legs (see the Foot Pain Video, even though you have no pain) and also see how your balance is barefoot standing on one leg. If that’s easy – try it with your eyes close (don’t fall!). You should be as steady and as solid as a tree – both legs – for at least 20+ seconds eyes closed.
      I’ll have a video on this hopefully within the week.

  60. My feet are Tender to the touch on top sides of both feet little bones their Don’t take much to re-injury them When I do twist them takes a lot of time to start feeling better.. They never are without some pain or tenderness.. Been going on for couple years. Do you have any suggestions ??

  61. Dr. Gangemi,

    Can peroneus trigger points also be a factor in over-pronation problems? I seem to have tight peroneus muscles (all three of them), but without the typical “referred pain” associated with those muscles as per the books and websites on trigger points.

    • Most likely not. The tight peroneus muscles are most commonly from a weak tibialis posterior.

      • Thank you. Regarding this text from your article:

        “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.”

        I definitely have this. Where would the discomfort on the inside of the calf muscle, along the inner edge of the tibia, be coming from? Is it basically tibialis posterior trigger points?

  62. Hey doc
    My 12 y.o daughter has been walking inwards even since she could walk I took her to the doctors when she was little so I did that hasn’t worked at all and now she has being getting really bad knee pains so I took her to her doctor and he said her left side of her body is a lot longer then her right. Her left foot is a whole sizes smaller. Then her right, the doctor sent her to the hospital and the doctor there made her have x-ray and they showed her back was 3 degrees out and he sent us home I told us to come back 12 months later and she feels worse wot shall we do. She is going back in june.

    • Something like this you really need to find a doc or therapist who understands how to treat the entire body, understanding the connection between all the muscles and the influence of the foot on the back and vice-versa.

  63. If I am understanding your article correctly you are recommending the opposite of what I’ve been told. I started getting bad foot pain last summer after three days of running on the beach without shoes. I started seeing a physical therapist one week later when I found that the pain was not going away. She found that I overpronate. She recommended that I use stability shoes and she also recommended several stretches and exercises to help strengthen my foot muscles. Wearing sneakers, particularly stability shoes really helped to relieve the pain. Since I insisted on increasing my distance running (I am currently training for a half marathon) I added superfeet to my shoes. This has help reduce the post tib pain I get for the longer runs. I still get pain on my feet but the pain nowhere near what it used to be. I can’t see how minimalist type shoes will help me especially since running barefoot is what started the pain to begin with. Can you maybe clarify for me?

    • If you’re thinking my philosophy is the opposite of the norm out there then yes you’re reading correctly. Read “Healthy People = Barefoot People” as that and the many other articles will teach you why you got injured like that. You didn’t get “injured from running barefoot” you got injured from running too much barefoot when your body wasn’t ready to run barefoot. Huge difference.

  64. I am bow legged, and so my feet naturally over pronant. I’ve switched to a transitional shoe, and increased my cadence, but that seemed to make it worse. I’ve gone to have my stride evaluated, and I can plainly see my foot over pronant, and then my inside of my ankle collapse as I fully put weight on it. I was given some ankle strengthening (and hip) exercises for my form, but told to go back to my regular running shoes until my pain goes away.

  65. Hi Soc Doc,
    While reading about a certain arm toning device, (the dumbell that you shake) I read an opinion that it should not be done until posture is corrected, or else the weight/movement would just make the posture problem worse. That got me thinking about the use of weights or even bands, etc. in general and the possible effect on my forward-curved neck. What do you think? Could that device, weight training or even training with bands make the posture problem worse?
    Thanks.

    • Any device that is used improperly can make issues worse. I think the shake weight is a terrible device anyway.

      • Do you think that because the shake weight doesn’t work, or because of the short, repetitive motion required?

        • I think it’s a gimmick and people need to be moving and doing functional movements, not holding a little weight that claims to tone a specific area. Same reason why I think most band type exercises are worthless.

  66. hi doc I have been told I have collapsing feet this pronation condition about 3 yrs ago which im sure is due to an injury my question is that my knees are starting to look like they have this pronation as well and when I stand normally my knees just about point inwards n I get a lot of pain after walking both in my knees and inner ankles I was wondering what this is n how I can help it

  67. I have a problem that started almost 3 years ago. it feels like i am losing control of my left lower leg. my foot rolls inwards a lot while i am running. i have been diagnosed as a sciatic nerve, dystonia. Have had MRI of neck, back and knee. I have done physical therapy and nothing seems to help. to me it feels like it is something behind my knee. Because of this problem it throw everything off. i feel like its a nerve that is trapped behind the knee, because the foot pronates excessively when the knee is bent. if i keep the leg straight the foot will not roll as much. but it is almost impossible to run with a straight leg. there is no leg or knee pain, i only feel pain when the foot starts to roll.

    • Yeah this is something that really needs to be looked at by a doc or therapist as I discuss in most recent article. http://sock-doc.com/2013/02/recover-prevent-injuries/

      • Dimas santos says:

        thanks,but after seeing 4 different doctors,not including the 2 in UVA,where i went 4 times they put me on a treadmill,i was hoping they would do an mri of my left leg,after all that’s what i was complaining about,my symptoms have always been the same,losing control of my lower left leg and the foot pronates excessively,running 10 miles or so like that puts my hip and knee in a awkward position,i have done everything i was asked to do mri’s ax-rays medicine for dystonia exercises physical therapy even tried a chiropractor for 3 months,never got the mri of my lower leg,i was told that it wouldn’t reveal anything,today is my last physical therapy appointment for the second time,nothing has changed witch now the’re telling me it could possibly be my right shoulder,after almost 3 years yesterday i came up with something,i wont reveal it right now,till im 100% sure,last night i ran my first mile in almost 3 years symptom free,you’ll probably think i’m crazy lol,but i’m super excited been up all night just thinking about,its almost to good to be true,thanks for all the info you post take care and keep on posting i’m sure its helped a lot of people!! :)

        • Hi Dimas,
          I’m dying to know what your findings were… please share! And congratulations on running symptom free – I know you must be elated!!!!

  68. Hi Doc, my 16 y.o. son’s entire right side is shorter than his left (1/2″ difference in his legs). His right pelvic bone is smaller, right shoulder blade is lower, etc. It’s something I didn’t notice till around age 11 but surely he was born that way. He plays soccer and obviously this slows him down. Is there anything we can do to help with performance, and especially to prevent future problems? Would an insert to add height help at all? Would it help to see any type of specialist? He saw an orthopedist who did xrays but had no advice. Thank you.

  69. Hi there
    Nice to meet you electronically.
    I’m bow-legged, so I overpronate as a result of the shape/structure of my legs/ankles/feet and how they fit together, rather than as a result of issues I can work on or correct.
    I don’t have constant pain, but my ankles are often sore first thing in the morning and I do find it quite painful to walk/stand barefoot for an extended period of time, especially on hard surfaces.
    What would you suggest for me? Does your advice change because overpronation truly is a problem, rather than a symptom in my case?
    Thanks in advance for your help. You are incredibly generous with your time on your websites.

    • From my experience with this and even those who are told they have abnormal Q angles, it is still not an issue. Your body – the muscles – should be adapting. So although you might not have a perfect/beautiful gait because of some structural deformity, it should not result in pain. Yes, there are exceptions and maybe you are one but my hunch is that you’re not since you have pain just waking up in the morning.

  70. Gilberto Herrera says:

    Very interesting article. It is great that you separate symptoms from causes. In any event, I believe I am an individual who suffers from a left shoulder problem because of an old injury to the right foot. And I am hoping you can HELP Soc Doc. First my apologies in advance for the length of this post, but I think you can help. Here is the chain of issues I have found. My gait on the right foot is such that I land on the outside of the foot but I stay in a supination position as I roll through. Also, my weight stays on the outside of my right foot when I stand at rest. I think I I found that while laterally shift my hips over the left foot because of this, weird. Then the lateral shift of the hips causes a slight rotation of my hips towars the left. Also the lateral shift of my hips causes my left hip to be higher than my right hip. Therefore, my spine tilts to the right starting at what feels like the top of L1 vertabrae, consequently my left shoulder is high, right shoulder low while the shoulders rotate to the right to counter balance the hip rotation to the left. And to top it all off my head tilts to the left. Before reading this post I thought my problems started in the hips, specifically the Psoas, Illiac, and other pelvic muscles. But now I think it is the right foot. By the way, I first injured my right foot long ago. I ran towards second base hard and instead of stopping by sliding I jumped over the tag, the front of my cleats caught the bag, slipped and turned perpendicular to my running angle and was trapped against the base. Therefore, my body rolled over the foot from a full spring. The ankle was quickly swollen and never treated, just taped it and kept going. Subsequently, I ran a marathon after only 4 weeks of training and the injury resurfaced after pounding the pavement over the 26.2 miles.X-Rays were taken after the marathon and there were no bone structure issues. Other than my body aligment and weight distribustion issues, it is difficult for me to pronate my right foot during my gait. Do you think all of these events and body alignment symptons are related? And before I run to my Dr. with this idea, is there anything I can do to test the theory? Thank you so much.

  71. Hi Sock Doc,

    I have flat, wide feet, and I supinate, I have ankle pain (I sprained my ankle real bad years ago and it has never been the same since, still swollen), and I have overall feet pain when I exercise. They also tend to curve inward. I like to do Zumba. I have been to a podiatrist and had xrays done a few years ago. No fractures, but he did recommend custom orthotics, which I am sure I do need, just have not purchased yet. I currently wear New Balances when I Zumba, I also tried an ankle brace for a while, which really did not help. Would you have any recommendations for a good shoe/sneaker for my supinated, flat, wide feet? Thank you so much!

  72. About 9 months ago I started playing alot of golf. The more I played the more I got this pain which felt like it was on the bottom outside of the achillies on my back right foot. I would get this pain after I would fallowthrough (after the swing). Even after golfing, when just laying around the house I would have a slight chronic pain of it. Didnt think much of it till I started playing basketball and I started noticing whenever i would make a sharp move or really try to jump high ,over pronate, I would get a serious shooting pain that felt like my achillies had just givin out… After about 15 seconds the pain would go away and I could return to play. Its been about 8 months now and I still have this problem.. With golf season coming fast I would love to have this fixed. Any advice you have would be greatly appreciated. The pain is primarily lateral to my ankle and to the bottom right side of the achilles. Thank you!
    Jesse

  73. Hi Sock Doc,

    thanks for all the time and advice you give to helping people here.
    I’ve been having pain on the outside of my left ankle just below and in front of the ankle bone, and sometimes to the left side of the achilles tendon, for about six months. It’s a sharp pain when weight bearing, particularly when pushing off the left foot that I believe is caused by overpronation, which is in turn being caused by a slight twist in my pelvis. I dance lindy hop regularly (very energetic dance with weight being carried a lot through the balls of the feet) and wear fairly minimalist shoes for both dancing and everyday activities (such as Fred Perry flat plimsolls or Keds sneakers). I’ve tried lots of things to help the pain – physiotherary, Alexander Technique, osteopathy – but not much seems to be working. Since being given orthotics five weeks ago the pain was significantly reduced at first, though my left knee started clicking, but now the pain is returning. Because I already wear minimalist shoes when the problem started, I’m not sure what else I can do: do you have any recommendations?

    Many thanks,
    Emily

    • Well as you hopefully learned from reading the article, overpronation doesn’t “cause” the problem, it is associated with or is another factor in the problem. Check out the Achilles Tendonitis Video I have here and see how that goes.

  74. Soc Doc:

    I am a 31 year old RN workig 12 hour days on a busy Med Surge unit at the city hospital. I am on my feet constantly. I am a 6’3″ 240 lb woman and I work in New Balance minimus shoes. I am moderately “knock kneed” and I slightly pronate. After standing or walking for a while I feel discomfort and a tiredness on the interior aspect of my ankle that goes to my arches. I thought I needed orthotics, but after reading your article I don’t know what I shoud do. Please advise and thanks in advance for your help.

  75. Hi, I’m pigeoned toed from the hip supposedly. Flat feet over pronator active athelete although now it kills me. I’ve been prescribed an aggressive left foot orthotic, hard plastic which cups the heal too. I was told by foot specialist my foot/ankle is not aligned right but surgery would be so extensive it’s not worth it. If I walk barefoot for any lenngth of time it kills me. Should I try it more? Does it do any good buyinbg expensive “stability” shoes with roll bars etc if you are already wearing agressive orthotics or does it matter?

  76. Hello Soc Doc,

    I’m a former athlete who is trying to get back into the habit of running. Some time ago I broke my right fibula and dislocated my ankle in a rugby accident. I now have fiitted a plate and 7 screws (ORIF). Since then I’ve gained a few pounds, not too much. But, even though I did all my physio, I get some soreness around the achilles tendon area towards the lower calf after I’ve been running. I notice that now, I have a slight over-pronation. I am using sometimes a corrective insole, but should I only use it on my injured foot? Please advise.

  77. Hi Sock Doc,

    I am a high school runner (female) who just recently became involved in the sport. I have naturally flat arches and I wasn’t aware of any overpronation prior to starting track. However, I purchased some minimalist shoes with a 4mm instep and I have realized that my overpronation has dramatically worsened. I’m confused….

  78. Hi Soc Doc,

    I have been wanting to run over the summer. but when I run my ankles hurt. I run with normal sneakers, but when I run with cleats my ankles feel great. Is this because of overpronation or something else? I don’t get it. Do I need to get a certain type of sneaker?

  79. Veronica says:

    Hey Sock Doc–

    I am 22, female, with Hypermobility Syndrome, and my feet definitely over pronate when standing/walking, causing hip, knee and lower back pain, and painful arch cramps (DXd by podiatrist years ago and given orthotics, which I never wear!). I am planning a 13-mile hike up a mountain in mid-July and don’t want to deal with pain during. I just found your site and am definitely going to do the exercises/barefoot walking as much as possible, but don’t have much time to really strengthen my arches much between now and the hike. Would a pair of mid-height boots without extra arch support still be a good investment for this trip? Pretty sure my muscles are lousy right now and I need good tread and ankle stability, since I’m still used to shoes right now, and not to walking barefoot on mountain terrain.

    Also, are there any arch exercises you can recommend, and how many reps and times per day to do them as sort of a daily over pronation “rehab”? I have already managed to rehabilitate a pair of weak, injured ankles to stability w/ physical therapy exercises over several months, so I am looking forward to fixing the pain of over pronation! Are these any good–
    http://www.dailymail.co.uk/health/article-2005272/The-barefoot-gym-workout-cures-arch-enemy–flat-feet.html

  80. I have navicular accessory of the left foot. I’ve been two years not walking/running and I’m gradually gaining more and more weight, which just puts more pressure on the foot. The doctors are leery of operating and I was told to “rest” it (I heard it is at times not a successful surgery), however, walking is not something I want to give up. I used to walk 5-15 miles and now I’m down to walking around the block. What is your suggestion without seeing x-rays, etc. I’ve been given a “boot,” custom made orthodics – none of which have worked and the surgeon wanted to cast me the last time. I’m a barefoot person (this happened while wearing Vibram 5 Fingers) and I can no longer walk barefoot at all. The only relief I get is when I wear Orthoheel flip flops. What would you do? Operate? MRI showed tendon very inflamed, however the larger part of the tendon is attached to the larger bone and not the accessory. Help!!!

  81. Tresa W. says:

    Hi Sock-Doc, I just did an online search on my most recent aching body part, which is my hips; they are stiff and achey when I stand after sitting for any length of time. I found that many symptoms I’ve been having are symptoms of ankylosing spondylitis: neck and shoulder aches since age 30, lower lumbar pain and subluxation just from bending over wrong, plantar fasciitis, shoulder-blade aches, stiff and sometimes painful knees, and now my hips. I even suspect the tennis elbow I had 2 years ago is related. I just lost my insurance, so I don’t think I’m going to see a rheumatologist yet for diagnosis.
    My question is, what do you think of an anti-inflamatory diet to treat this? Or the paleo diet?
    Thank you.

  82. correlon says:

    Hello Doctor. I have to ask some questions maybe you could help me?.

    Well, as a young guy I was very active; I played soccer and run maybe 4 miles 2 or 3 times a week.

    Never had any injury problems back then. But I have always been a heavy build guy and since I remember my shoes get wear out from heel to the front.

    Many years later I tried to play a little soccer and run a bit but I was (still today) fat and out of shape, so based on the wet foot and paper bag test I thought I was a Neutral runner. I tried to walk and run on a Neutral shoe (nike air pegasus 27) with a little fast pace and ended with a shin splint.
    BTW I never heard of shin splints until I realized I had one LOl. After recovering and loosing some weight I went to a “runners” store and they made me run with neutral shoes on and they recorded my gait.
    They told me I overpronate so they sold me some shoes with big support. The first the first 6 to 7 times of running on these felt very good but just not long ago I noticed that walking with the shoes wasn’t as comfortable as it used to be but I can run with them just fine.
    I feel while walking the heel is just massive but running they’re ok.

    My question is I’m I really an overpronator or maybe I just wasn’t ready to run in neutral shoes when I got injured?

    I’m running on Brooks’ adrenaline gts 13 and have a new pair of nike lunarglide+ 4 they suppose to be good for overpronation. But also have a pair of brooks pure flow and brooks racer st 5 they are more of a minimalist kind of shoe but I’ll use them when I know I’ve lost a lot more weight.

    what shoe will you recommend to work my pronation or over pronation problem?

    I grew up in a 3rd world country running with shoes that were more like tennis shoes or even volleyball shoes so I never heard of stability, motion or even neutral running shoes. Much less pronation, overpronation, supination etc. If you could help me I’ll appreciate it very much. Thank you. Sorry about my English.

    Btw I meant to say I wear out the soles of my shoes normally on the outside from heel to the front of the shoes. Thanks

  83. Shirley says:

    Hi Doc,

    Would you recommend going back to minimal shoes to someone who has had a posterior tibial problem?

    I had been running in Pure Cadence for about a year with no problems, before I briefly switched to a Saucony Mirage 3, which was apparently a neutral shoe, and promptly had the posterior tib and inner arch issue. To me it was a shoe problem and a TMTS as I had came back from illness after 2 weeks, and went straight to a 30km run in new Mirage 3. Stupid, I know.

    My PT/sports masseuse solved me of the posterior tib problem, and has gotten me to do some glute and hips exercises, which I feel were quite helpful. But my concern now is the shoes aspect, as obviously I am hoping that I will not injure myself at the same place again, but yet I refuse to go back to heavy stability shoes. My arches are low, but I believe with the right strength exercises minimal shoes should be the way to go. So what I’m asking is, should I go to a neutral, light shoe, or should I be looking at light performance shoes that have a little bit of support (like the Asics DS-trainer) for a little help at the arch area?

    Much thanks for listening, doc.

    • As I write about in “Healthy People = Barefoot People” if you really want to address structural problems and correct them (not support them) then you go as minimal as possible. This would be especially true for tib posterior problems. I have my patients barefoot as much as they possibly can be and in zero-drop shoes when not.