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.