October 07, 2015

How I Learned to Stop Worrying and Love Pronation

Much like alcohol and skinny jeans, experts have warned of the evils of pronation, and its equally evil twin, supination. Running shoe companies have built their reputations by promising to cure these terrible afflictions and hooded mystics have crafted all types of devices to slip into your shoes to correct these maladies. But maybe it’s time to slow down and really take a look at what pronation and supination are, and how they really affect runners.

Pronation and Supination Explained - Woman Running on Track

Simply put, “Pronation and supination are normal motions of the foot/ankle. Your body cycles in and out of these positions with every step you take. Most people have a resting foot position on one side of the continuum. Some are more pronated, while others are more supinated.” Aaron Swanson (Apr 28, 2014) demonstrates Pronation and Supination perfectly in this short video. 

But, wait…does that definition say pronation and supination are normal? Why, yes it does! When discussing pronation as it relates to running, it is the way the foot naturally absorbs shock by rolling inward slightly when the foot strikes the ground. Well, what about supination, then? Uh…no…there actually is no such thing as supination when referring to running. Technically, only your hand can supinate. The foot merely underpronates, which is usually caused be a high-arched, rigid foot. Conversely, overpronation is typical of a flat or low-arched foot.

So much like our friends over at snopes.com would do, here are 7 facts and myths about pronation and supination:

  1. Pronation causes injuries in runners…MYTH. As we discussed, pronation is a natural shock absorber. In fact, underpronation can cause running injuries, not pronation. Runners who underpronate are especially prone to plantar fasciitis. Now overpronation can cause problems, especially in the form of shin splints, knee injuries, hip injuries, and ankle injuries.
  1. Overpronation, therefore, needs to be eliminated…MYTH. If some pronation is normal, why would we want to eliminate it? Many over-zealous shoe fitters and insert sellers take the approach that all pronation is bad, and will not be satisfied until it has been totally eradicated. I have actually seen people come into my store walking on the outsides of their ankles because someone told them that they needed a motion control shoe combined with a rigid orthotic.
  1. Overpronation always needs to be corrected…MYTH. Here is the rub: there is no strict definition of what overpronation is. The reality is overpronation is only a problem if the runner is experiencing injury or pain. I have seen runners completely destroy the insides of their shoes they overpronate so much. Yet, for whatever reason, they experience no problems. They are functionally dysfunctional! If it ain’t broke, don’t fix it!
  1. How much you run may determine if you need to control pronation…FACT. Now we are getting somewhere. Jogging a mile or two a day in a cheap pair of athletic shoes may not cause the slightest problem. However, if you are training for a marathon and logging some series miles, all kinds of new problems may rear their ugly heads. That is why they are referred to as “overuse” injuries. Now may be the time to look at better shoes and/or inserts/supports.
  1. The right shoes will correct overpronation or underpronation…MIXTURE. Some shoes are better suited to certain types of feet. The conventional wisdom says that severe overpronation gets a motion control shoe, normal pronation gets a stability shoe, and underpronation goes with a neutral shoe. However, it is important to remember two important points. First, less is more. Use the least amount of correction as possible. Second, the latest study indicates that Expensive Running Shoes Are Not Better Than More Affordable Running Shoes. That sure opens a can of worms. However, a trip to a running specialty store is still a worthwhile endeavor in most cases.
  1. Custom orthotics are better than over-the-counter inserts…MIXTURE. There are two ways to look at correcting biomechanical issues of the foot. One is to take a mold of the foot and build a custom orthotic to fit that foot. The other is to make the assumption that there is an “ideal” position for the foot, the proper support should provide for the optimal foot position and mechanics. While there are foot types that may require correction well beyond what can be provided by an over-the-counter support, they are by far the exception, not the rule. While I have seen some success stories with custom orthotics, I have seen many more cases of still-injured runners with expensive pieces of plastic.
  1. There is more than one approach to correcting overpronation…FACT. Most supports take the approach of stabilizing the heel and/or the arch to limit pronation. However, a promising approach to the problem of overpronation is to provide support to the metatarsals (bones in the forefoot). This allows the foot to have a normal amount of pronation throughout the foot strike, while limiting it prior to toe off. Examples of these types of support are StrideTek High Performance Insoles and Sandals.

Obviously, this article has just scratched the surface in regards to the foot and biomechanical issues. Next up will be a fun article on alternative footwear! Also, stay tuned for articles about shoe fitting, shoes vs. inserts, cross training, qualifying for the Boston Marathon, training plans, nutrition, weight loss, and more!

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Larry LaHodny has a B.S. in Physical Education, with Emphasis in Sports Medicine from Willamette University and an M.B.A. from National University. Larry has over 20 years’ experience coaching runners, including at the youth, high school, and adult level. Larry has trained National Champions, All-Americans, State Champions, and Boston Marathon qualifiers.