Severe “overpronation”

“Overpronation” is a commonly used and misused term by runners and health professionals in the context of running injuries and the use of running shoes. Pronation is a normal motion of the rearfoot in which the ankle rolls inwards and the arch of the foot collapses. This is what the foot is supposed to do as it is how the foot adapts to uneven surfaces and absorbs shock. It is healthy and nothing wrong with it. The way some runners talk about what they have read about it, you would think that they have some sort of disease.

Where the problem arises is that overpronation is widely considered a risk factor for getting an injury when running. For that reason, there are design features in running shoes that are claimed to help runners with this overpronation. These are what are known as the motion control running shoes. In contrast, the neutral running shoes do not have these design features aimed at helping the so-called overpronation.

The problem with the concept of overpronation is that there is no consensus on what is ‘normal’ and what is ‘over’. Some runners with severe overpronation get no problems and other runners with only small amount get lots of problems. The actual evidence linking overpronation to injury is also very weak. The consensus of the systematic reviews of the evidence is that it is only a very small risk factor, so it is not really a big issue due to so many other factors that go into runners getting an injury.

So should overpronation be treated? Yes, if it is contributing to the problem. No, if it is not contributing to the problem. This can be difficult to determine. A key in determining if it is contributing to the problem is to determine if the forces in the tissues that it is causing are high enough to damage the tissues. The supination resistance test can be helpful here in helping decide this. If that test is high, then the forces are high, so the overpronation probably should be treated. if the forces are low, then it may not be necessary to treat it. For example posterior tibial tendinitis could be due to overpronation if the forces are high.

If it does need to be treated, then the cause of the problem has to be addressed. There is not a one-size-fits-all when it comes to overpronation. If a muscle weakness is the cause of the problem, then exercises like the short foot exercise will help (it won’t help other causes). If tight calf muscles are the problem, then stretching is what is needed (muscles strengthening or foot orthotics will fail in these); if a bony alignment, such as forefoot varus, problem is the cause, then only foot orthotics will help (strengthening muscles and calf muscle stretching will fail); and so it goes on. The cause must be addressed.

There are so many myths and nonsense being perpetuated about overpronation. A key warning sign is that whoever is talking or writing about it is, if they advocate a one-site-fits-all when it comes to it, then they probably do not know what they are talking about.

Craig Payne on behalf of Croydon Total Footcare. Craig regularly lectures and blogs about this topic addressing the myths and nonsense. It is one of his pet peeves.