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Pronation or Supination?

One of the wonderful design features of the human body is that we can do nearly any kind of activity without having to think about the functions in our body that must coordinate to make that activity happen. Even something as simple as walking or running is a complicated ballet of several structures – the muscular, nervous, skeletal, respiratory, and cardiac systems all must work together for you to keep your balance as you transfer your weight from one foot to the other.

Most of us are also not aware of the subtle movements our ankles and feet make during the course of a walk or run. Pronation is the inward roll of the foot during movement; supination is the opposite – the outward roll of the foot during movement. A certain degree of each of these types of movements is necessary to stabilize the body as the foot pushes through with each step, allowing body weight and its associated impact to be evenly distributed throughout the foot. However, when the foot and ankle roll too much one way or the other, problems occur.

Over-pronation and the less common over-supination (also called under-pronation) can be caused by a variety of factors. Structural leg abnormalities (such as bow-leggedness and differing leg length), weakness in leg and core muscles, overly-loose tendons, pregnancy, and extreme arches (either too high or too flat) have all been blamed for these conditions. Additionally, wearing the wrong type of shoes can exasperate the condition or even influence a person to over-pronate or supinate that might not normally.

Because over-pronation and supination can cause a host of injuries (such as shin splints, ankle sprains, Achilles tendonitis, and pain in the knees, hips, back, and feet), it’s important to address it for your overall health and comfort while being active. Fortunately, almost all cases are easily treatable.

If you suspect your injuries may be due to over-pronating or supinating, your first stop should be your physical therapist or podiatrist for a foot strike and gait analysis. It’s important to know both the type and the degree of severity of your condition before you attempt to correct it (for example, trying to treat over-supination with orthotics for over-pronation not only won’t help, it may even make your injuries worse).

Assuming you are without structural leg abnormalities, your next stop will likely be the shoe store. Mild over-pronation can often be treated very effectively with shoes made specifically to correct the issue. Called “motion control” shoes, these shoes will have extra padding and stability on the inside of the shoe to both protect your foot and redistribute shock forces. Those with more severe over-pronation may need to look at orthotics, which can be purchased both off the shelf or custom made (if your over-pronation or supination is due to an extreme arch type, you will likely need them custom made). The few individuals that truly over-supinate usually need nothing more than a neutral shoe with lots of padding to redistribute weight and protect the small toes from impact.

Once you have the correct shoes and/or orthotic inserts, your related pain symptoms should resolve. Treat minor symptoms with RICE (Rest, Ice, Compression, and Elevation), and see your physical therapist for more severe pain or stubborn symptoms that don’t resolve. If your over-pronation or supination is due to muscle weakness, your physical therapist will be able to recommend a strength and conditioning program to correct the problem.

It’s a shame to let something as easily treatable as over-pronation or supination get in the way of the activities you love. Call your physical therapist today and take the first step in addressing the problem. Keep moving, my friends!

– Alan

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