Mythbusting Monday: Pronation

If I had a dollar for every time someone shamefully brings up that they pronate when they run, and asks how to work on it, I could fund my fancy coffee habit. How do I normally respond to this? I say "Everyone pronates! It's actually an important part of the gait cycle!" Most people are surprised to hear this - pronation is used like a dirty word by some running influencers and shoe brands. However, it's true - pronation is a normal, and good, component of running and walking gait. Having too much OR too little pronation can be a problem and can be associated with injuries. This is why it's important to understand more than just if you pronate while you run, but also how you pronate. Let's break it down.

What is Pronation?

Simply put, pronation of the foot and ankle is when the midfoot rotates inwards towards the ground and the outside border of the foot rotates upwards away from the ground. Biomechanically, pronation is a combination of calcaneal (heel bone) eversion (bottom of the heel moves away from midline), ankle dorsiflexion (foot top of foot and lower leg get closer together), and forefoot abduction (toes move outwards away from midline). The opposite of pronataion is supination, when the inside of the foot scoops upwards.

Image sourced from footdoctorokc.com

Pronation's Role in Running

When the foot makes contact with the ground, it is usually with the center or outer part of the heel. Most people land in a small amount of supination, and the motion to achieve a neutral heel position is, you guessed it, pronation! We then expect to see the foot enter into pronation at midstance, and then supinate to neutral or a supinated position before push off.

Pronation is important because it takes the foot and ankle complex from being rigid at initial contact to flexible in midstance. Rigidity is important at initial contact because this helps us to safely transfer weight onto that foot without the ankle collapsing. The flexible position of the foot is important as we accept weight onto that limb because it helps disperse forces and accomodate to uneven surfaces. Pronation helps contribute to shock absorption while we run, and is very important!

When Pronation Becomes a Problem

Pronation can become problematic if there is too much pronation (overpronation), if pronation occurs too quickly from initial contact to midstance (fast pronation), or if the foot is pronated for too long during the gait cycle (prolonged pronation). These are mainly an issue because they cause increased stress and strain on various body parts including the plantarfascia, posterior tibialis tendon, and Achilles tendon. They can also be linked with problems at the knee and hip if the increased pronation causes more tibial internal rotation, knee valgus, and femoral internal rotaiton and adduction. It's important to remember that these issues higher up the chain can influence what is happening at the foot and ankle, so it's important to assess hip strength when we see increased pronation, because that can be part of the issue. In these scenarios, pronation problems can cause or irritate plantarfasciitis, Achilles tendon problems, and knee pain including patellar tendinopathy and IT Band syndrome.

This problematic pronation can be addressed with intrinsic foot strenthening, eccentric posterior tibialis strength, hip strength, and dynamic arch exercises. In some cases orthotics or shoewear changes can help pronation control, but I like to address the underlying strength and motor control deficits to get to the root of the problem.

The Dangers of Insufficient Pronation

Just like excessive pronation can be a problem, insufficient pronation can also cause issues. With inadequate pronation, there is poor shock absorption by the foot, and more likelihood that those forces travel upwards causing problems in the shin and knee. This can include shin splints, stress fractures, and knee pain.

Insufficent pronation during running is often related to ankle stiffness, and people who lack this movement may need to work on ankle dorsiflexion and midfoot mobility as well as calf flexibility and motor control.

Key Takeaways

• Pronation is an important part of the gait cycle and you SHOULD pronate, so stop treating it like it's a bad thing!

• Both excessive and insufficient pronation can result in injuries. We can work on the causes of either over or under pronation by addressing strength, mobility, and motor control deficits to reduce injury risk.

• A running gait analysis can help determine if your pronation is too much, too little, or just right, and what structures should be addressed to optimize pronation.

Thanks for reading!

Dr. Elizabeth Karr PT, DPT