Hang around any running club long enough and the talk will invariably turn to running shoes. Much of the banter will be about whether or not you need cushioned shoes or if custom orthotics are the way to go…

…But all the talk revolves around one term and that is pronation.

On that note, let’s have a detailed look at pronation, overpronation and supination.

What Is Pronation?

Pronation refers to the natural movement of the foot rolling inwards when you walk or run.

Your gait determines whether you have a neutral pronation if you overpronate or underpronate (also known as supination).

If you overpronate or supinate it puts more stress on certain areas in the feet & leg, which increases your risk of injury.

Different types of shoes can help support your feet if you find that you are overpronating or supinating and it’s causing you pain.

Neutral Pronation

Neutral pronation defines the natural inward roll of the foot when it strikes the ground. 

Pronation helps absorb the shock of landing on the ground when you walk or run and keeps the ankles and legs aligned. 

If your foot doesn’t pronate, the shock of every step would impact the mechanisms of your lower legs.

During neutral/normal pronation, the arch of your foot will flatten as the heel lands on the ground. Your weight is then shifted to the outer side of the foot and then transfers to the big toe.

Your foot will then roll outward, the arch will lift and stiffen and all of the toes will push off and provide stability. 

With a neutral pronation, the sole of the foot will directly face backwards and is not tilted inward or outward.

Pronation also helps to stabilise the body on different types of terrain by adjusting the way the foot lands on different terrain.

If you have neutral pronation you can generally run in any neutral running shoes which provide support and cushioning specifically designed for a neutral gait.

Overpronation

This occurs when the foot rolls excessively inward when you walk or run. 

Overpronation puts more weight on the inner side of the foot and also puts a greater strain on the big toe and the second toe. 

This distribution of weight destabilizes the foot and in turn, affects other biomechanics of the leg.

The excessive twisting or rotating happening in the foot and ankle when you overpronate causes the tibia also rotates more than it should. This causes knee pain and shin splints (medial tibial stress syndrome).

One of the most successful ways of preventing overpronation is to wear stability running shoes. These motion control shoes offer a lot of support and structured cushioning.

Stability running shoes generally have firm cushioning along the inner side of the shoe where the foot arches to provide extra arch support. This cushioning helps to prevent the excessive inward rolling of the foot that occurs with overpronation.

Supination (Underpronation)

Supination, or underpronation, occurs when the foot rolls along the outer side of the foot when you walk or run. 

With neutral pronation, the foot naturally supinates as the heel lifts off the ground and the pressure is then rolled across the toes before the foot lifts.

However, when supination occurs, more pressure is put on the outer, smaller toes instead of the big toe and the second toe.

People who supinate usually have higher arches that don’t flatten sufficiently when the heel strikes the ground. 

It also correlates with certain running injuries, such as plantar fasciitis, ankle injuries, Achilles tendonitis, and iliotibial band syndrome.

Runners with supination should choose a pair of neutral running shoes with lots of cushioning as supinators are particularly susceptible to shock-related injuries and commonly get stress fractures. 

Extra cushioning in the running shoes will help absorb some of the impact from running or walking.

How To Choose Running Shoes

Whether you pronate, overpronate or supinate, making sure you run in the correct running shoes is important if you’d like to stay injury-free. 

This is how to make sure you’re in the right shoe:

How To Determine Your Level Of Pronation

Figuring out whether you overpronate, supinate or have a neutral pronation is essential for choosing the right pair of running or walking shoes. 

There are four ways to self diagnose your level of pronation but if you are unsure you can get assessed at a speciality running store.

  1. The wear test

The most common method of determining your level of pronation is the wear test. If you have a look at the soles of your old or current running shoes, you should be able to identify the way your foot is landing.

Overpronators will find more wear on the inner side of the foot and the ball of your feet towards the big toe. Supinators will see more wear down on the outer side of the shoe and people with neutral pronation should see an even distribution of wear along the centre of the shoe.

  1. The wet foot test 

You can analyze your footprint by doing the wet foot test. Wet your foot in some water and then step onto a piece of cardboard. You should be able to tell how your foot lands by the thickness level of the area in between the ball and the heel of the foot. If the line is very thin, it’s a sign of supination, whereas if it’s very thick, you are overpronating.

  1. Shoe tilt

Take a pair of shoes that you wear regularly, they can be running shoes, trainers, or boots, and put them on a flat surface with the heels facing you. If you notice the heels tilt inward as a result of wear along the inner side of the shoe, you are likely an overpronator. If they tilt outwards due to wear along the outer edges of the shoe, you are more likely to be a supinator.

  1. Professional assessment

If you go to a good quality running shoe store, or a specialist practitioner such as a podiatrist you can ask for a foot or assessment from an expert. Someone who’s been trained to identify the different levels of pronation and recommend the best shoes for that type and level.

You can bring your old pair of running shoes with you so that they can analyze the wear themselves and make a more informed diagnosis. They will also usually ask you to walk or run so that they can see how you move for themselves and that they can do an extensive gait analysis.

Is It Overkill To Run With a Stability Shoe & Orthotics?

While cases are always individual and hard to comment on without seeing the client in person, there are common mistakes that are made…

Say, for example, you’ve always run with orthotics in a neural shoe as you’re a flat-footed pronator. 

Then you changed to a stability shoe and continue to insert the orthotics, coupled with extensive strength training as a desperate attempt to curb your ITB. 

Now you’re asking yourself if it is overkill to run with a stability shoe and orthotics…

The fact that this is an injury that is not clearing up and sounds like it’s potentially gotten worse by the latest change. 

Taking all those things into account and obviously, the experience that I have gained over the last decade in terms of dealing with ITB, I see a lot of common mistakes here.

So, probably the last place I would look for a causal relationship with ITB is foot mechanics. 

The last thing that will cause ITB is pronation. 

So, ITB is actually a supination injury. 

To try to simplify it a little bit, if you pronate and much more important than that if you pronate excessively because pronation is normal, it is our body’s first line of defence, it’s our first line of shock absorption.

Pronation would create pain on the inside not outside of the foot/leg.

If you go and stick an orthotic or put on a shoe that is going to disrupt that pronation, you’re actually disrupting your body’s first line of defence against the impact of running.

So, we really need to be clear that we are excessively pronating and that that excessive pronation is causing us problems.

If we excessively pronate, we are far more likely to get pain or discomfort on the inside of the knee, not on the outside of the lateral aspect where we get ITB. 

That’s the first and very important thing to establish. Similarly, being flat-footed, particularly if you spent a youth without shoes, is quite normal and it’s very normal for our ancestors to have extremely flat feet.

Again, for me, putting in anything or wearing shoes to compensate for flat feet is really,’ a crazy notion and if your feet are so flat-footed that they’re causing you problems, you will have foot pain on the inside of the foot or ankle and on the inside of the knee, not the outside.

I think it’s really important to be absolutely 100% sure that we need orthotics – full stop. 

Orthotics are pushing you to the outside, and motion control shoes are pushing you to the outside. You should pretty much never have a situation where you have orthotics and a motion control shoe. 

Orthotics should only ever be in a neutral shoe and only when it’s really, really required.

Tight muscles, not orthotics causing your ITB problem…

In my opinion, ITB, almost always, is something that is causing stress on the outside. Adding orthotic in motion control shoe increases stress to the outside, so I don’t see a solution to the problem there.

More often than not, the problem lies with tight hip flexes, weak glutes and potentially tight glutes, but because of modern lifestyles, people driving so much, people sitting at their desks. I always look at numbers one and two, tight hip flexes, and weak glutes because of how much we sit.

Unfortunately, that often presents as a tight glute. This is because if you have very tight hip flexes, when you stand up, you don’t walk around bent over like you’re bowing to everybody you see. 

The pressure of that tight hip flexor has to go somewhere and it normally goes into the femur, we have a slight internal rotation of that femur which then tightens up the glute and then people go, oh, tight glute.

So we stretch the glute, but by overstretching the glute we make them even weaker. This means that there’s an even more of an internal rotation from the femur. 

If you really stretch those hip flexors, do a lot of strengthening on the glute and then do some stretching on the glute, but don’t overdo it, if you tackle those things, then you normally will take care of ITB.

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