Pronation and Supination: Exercises and Treatments

Pronation is the natural movement of your ankle in a side-to-side motion as you walk or run. When you walk or run, your toes help to push your bodyweight off of the ground, with your big toe and second toe doing most of the work. As this happens, the weight of your body shifts inward to the arch of your foot, which causes your ankle and foot to shift slightly inward. This natural pronation is controlled by the posterior tibialis muscle which runs from the ankle up the inside of the lower leg.

Overpronation is when the foot rolls further inward and downward than it should during normal pronation. As the ankle collapses inward, the big toe ends up straining to push off with each step. Overpronation is common in people with weak foot arches or flat feet. If left untreated, overpronation can cause you to develop a postural imbalance with a twisting of the lower leg, which can lead to shin splints, knee pain, heel pain, sprains, and strain of the posterior tibialis tendon. Overpronation running injuries can be prevented by choosing the right shoes with motion-stabilization capabilities.

Supination, or underpronation, is the opposite of overpronation. When supinators walk, they put most of their weight on the outside of the foot. This leads their outside toes to overcompensate and take most of the weight as they push off with their feet during walking or running. Supination is common in people who suffer from iliotibial band syndrome, plantar fasciitis, and Achilles tendonitis, as well as in those with high arches. People who suffer from bunions or calluses on the inside of the foot can also develop supination.

Overpronation and supination are both overuse injuries that runners practicing improper form may experience. Here are some tips for addressing overpronation and supination.

1. 1. Consult a physical therapist or podiatrist. If your pronation or supination is causing ailments like heel pain or back pain, consult a physical therapist or podiatrist and review your treatment options. Physical therapy can help you reorient the way that you walk, thus relieving your pronation or supination.
2. 2. Work on your running form. A running coach will be able to analyze your running form to determine if your gait, posture, or footfalls are exacerbating your overpronation or supination. You can also go to a running store and have a running expert perform a gait analysis to diagnose any excessive pronation problems.
3. 3. Address your running shoes. The wear on the soles of your shoes can give you an indication of whether you're overpronating or supinating. Place a pair of old shoes on a table and see if you notice them tilting one way or the other at the heel end. An inward tilt could be evidence of overpronation, while an outward tilt could be evidence of supination. If you overpronate, you may benefit from buying a pair of motion-stabilizing shoes or custom orthotics. For people who overpronate, motion control shoes can help you stabilize your gait. Custom orthotics are another good solution both for those who overpronate and those who supinate. The cushioning from insoles will encourage foot pronation to level out.
4. 4. Strengthen your feet. There are a number of exercises you can do to improve the strength of your feet and change the way you shift your weight. Exercises like arch lifts, calf raises, pen lifts, and more can help improve the strength of your overall sole and prevent you from shifting your weight too far in or out on your feet.

If you suffer from overpronation, here are some simple exercises you can do at home to strengthen your feet and offset the effects of this overuse injury.

1. 1. Arch lifts: Begin with both feet planted on the floor. With your heels and toes planted on the floor, lift your arches off the floor on hold for three seconds. Release your arches and repeat the exercise.
2. 2. Clamshells: This exercise strengthens your side, which can help you compensate for overpronation. Lie on the ground on your side, with your knees bent and your ankles together. Open and close your knees while keeping your ankles together, like a clamshell. For extra resistance, add an exercise band around your thighs.
3. 3. Pen lifts: Place a pen lengthways under the toes of one foot. Scrunching the toes under and lifting your foot, try to clasp the pen and lift it off the floor. Lower the pen back to the floor and release it. Repeat the exercise on the other side.
4. 4. Plantar fascia stretch: Lift one foot up and cross it over your other knee. Wrap your fingers around the big toe and draw it back towards the top of the foot. Hold for 5 seconds and release. Repeat.

For those who suffer from supination, you can perform these exercises from a chair or standing position.

1. 1. Calf raises: Begin by standing with both feet planted firmly on the floor, then lift your weight up onto the balls of your feet. Perform ten to fifteen calf raises, taking your time to slowly and deliberately move through the action. Be sure to check the alignment of your ankle by keeping all ten toes on the floor, with a balanced distribution of weight.
2. 2. Hamstring stretches: From a standing position, bend forward at the hips and reach towards your toes. Keep your knees straight or slightly bent depending on your flexibility. Stay in the stretch and continue to breathe to allow the muscles to relax.
3. 3. Jumping rope: You can practice jumping rope with bare feet on a carpeted floor to reorient how your weight hits the ground. Click here for a beginner’s jump rope workout.
4. 4. Plantar fascia stretch: Sit on a chair with both feet planted on the ground. Cross one ankle over the other, and pull your toes back to the front of your ankle.

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