Overview

When we walk or run, the foot naturally rolls inwards slightly after landing on the outer heel, in order to distribute body weight and aid shock absorption. This is a normal process in the gait cycle, and is called pronation. However, when the foot rolls too far inwards upon landing, this is known as overpronation. This usually happens to people with low foot arches or flat feet.¹ It can also be caused by pregnancy, obesity, or walking or running on hard surfaces for extended periods. 

Overpronation can increase the risk of injury due to excess strain on the muscles, tendons and ligaments that support the foot arches.² Fortunately, overpronation can easily be helped with specially designed shoes. 

Read on to find out if you suffer from overpronation, what the consequences may be, and how to help prevent it. 

Understanding pronation

Pronation is the natural turning of the sole of the foot so that it faces downwards.³ Pronation occurs when more weight is placed on the inside of the foot when walking or running, as opposed to supination, when more weight is placed on the outside of the foot.² 

Pronation is a normal action that is required for shock absorption. It allows impact to be distributed evenly when the foot lands. In a normal gait, the foot lands on the outside of the heel and then rolls inwards (pronation) to support body weight and absorb shock.² 

Overpronation defined

Overpronation is the excessive inward rolling of the feet. This happens when you have low foot arches or flat feet. The foot lands on the outer heel but then rolls too far inwards, causing excess weight on the inside of the foot, rather than the ball of the foot. This can cause a range of injuries such as shin splints, plantar fasciitis, bunions and heel spurs.¹

Common causes of overpronation

Overpronation occurs in people who already have flatter feet, very flexible feet, or low foot arches. It can also be caused by certain lifestyle factors like obesity and running or walking on hard surfaces for long periods. Overpronation is also often observed during pregnancy due to the added pressure on the feet.² 

Identification of overpronation

Footwear wear patterns 

Overpronation can easily be identified by looking at the patterns of wear on your shoes. Overpronators will find their shoes tend to wear down most on the inner edge, including the heel and ball, and on the big toe area. This is opposed to neutral pronators, who will have the most wear on the outer heel and across all toes, and supinators, who will have the most wear along the outer edge of the shoe.² 

Gait analysis 

It is always important to seek professional advice before making any assumptions. Many running shops will offer a gait analysis service to help you identify your pronation type. This can be done using a video of you walking or running, or in-store where you will be asked to walk along or run on a treadmill while the professional watches your feet. Many athletics shops also have an online ‘shoe finder’ which will ask you a few questions in order to match you with suitable shoes, such as this one from ASICS: Shoe Finder: Guide to Pick the Right Running Shoe | ASICS UK ⁴

Effects of overpronation

Impact on the foot

Overpronation can cause stress on the foot arches and on the muscles, ligaments, and tendons that support the arches. This can make walking painful and can increase the risk of foot injuries such as plantar fasciitis, bunions and heel spurs.² 

Plantar fasciitis

Plantar fasciitis is a condition that causes pain on the underside of the foot around the heel and arch. The pain is most notable after sleeping or resting or when you start walking. People with plantar fasciitis often find that the pain subsides during exercise but returns after resting. A common symptom is being unable to lift your toes off the floor. You can usually ease the pain yourself by resting the foot and keeping it raised when possible, putting an ice pack on the painful area for 20 minutes every few hours, wearing shoes with cushioned heels and good arch support, and performing gentle stretching exercises. Over-the-counter painkillers like paracetamol and ibuprofen can also be used to ease the pain. If you are overweight, it is advised that you try to lose weight to help ease the pressure on the foot. Try to avoid walking or standing for long periods or walking barefoot on hard surfaces. Do not wear high heels, tight, pointy shoes, flip-flops or backless slippers. If symptoms persist for more than 2 weeks or are very severe it is advised to visit your doctor, who may refer you to a physiotherapist or podiatrist (foot specialist).⁵ 

Bunions 

A bunion is a painful swelling on the joint at the base of the big toe. Over time, extra bone can grow where the base of the big toe joins the foot. This happens when pressure on the foot compresses the big toe and pushes it towards the second toe, which can be a result of overpronation. Bunions can cause pain along the side or bottom of the feet, which is usually worse when walking or wearing shoes. Bunions cannot be got rid of yourself, but the pain can be eased by wearing wide-fitting shoes with a low heel and soft soles. You can also purchase bunion pads from pharmacies, which stop the bunion rubbing on your shoe. It is advised to see a doctor if the pain stops you from carrying out normal daily activities or if the bunions are getting worse. They will suggest solutions to help ease symptoms and might refer you to a podiatrist who can suggest special insoles, toe spacers and toe supports. In severe cases, you may be referred for surgery to remove the bunion.⁶ 

Heel spurs 

Heel spurs are bony growths on the back or bottom of the heel bone. These grow inside the foot and are not usually visible but cause pain. They occur when the foot ligaments are under stress, such as in overpronation. Heel spurs are similar to plantar fasciitis and can result from plantar fasciitis as the body responds to stress and inflammation on the foot by building extra bone tissue. Most people do not notice that they have a heel spur until they feel pain in their heel, and this pain is often mistaken for plantar fasciitis. Heel spurs do not go away, but symptoms can be managed the same way as plantar fasciitis. Surgery to remove a heel spur is very rare, and they are usually removed as part of plantar fasciitis surgery instead.⁷ 

Influence on the lower body

Overpronation can cause the legs to rotate during the walking cycle, leading to consequences that extend beyond just the feet. The rotation of the legs causes alignment issues, which can affect the knees, hips, and lower back.^8,9 

Knee and hip problems

Overpronation causes the legs to rotate inwards, which can result in the hip joints becoming misaligned. This puts extra stress on the hip and leg muscles, which can become painful. The inward rotation of the lower leg can also put additional force on your knees. This causes excessive rubbing and strain on the knee joint, causing pain.⁹ 

Shin splints

Another common symptom of overpronation is shin splints, which is pain and tenderness along the shin bone of the lower leg. Shin splints are caused by repeated stress on the shin bone and the connective tissue that attaches the muscles to the bone. They are not serious and can be healed with rest, ice, and supportive shoes.¹⁰ 

Lower back pain 

Due to overpronation causing the legs to rotate during walking or running, the pelvis can tilt forward, increasing the curvature of the spine. This puts strain on the muscles and ligaments of the lower back, potentially causing lower back pain. There is a higher risk of this occurring if one foot overpronates more than the other.⁸ 

Causes of overpronation

Structural factors

The most common cause of overpronation is flat feet, which is where a person does not develop foot arches. People who already have flatter feet are more likely to develop overpronation. Another common structural factor leading to overpronation is fallen arches or adult-acquired flat feet. This is where the foot arches have collapsed due to injury of the tendons that support them.² 

Some people have shorter bones in one leg than the other. This can lead to overpronation. On the contrary, overpronation in one foot more than the other can also cause the leg muscles to shorten as the pelvis rotates to compensate, becoming misaligned. This causes the whole leg to shorten as it is pulled higher up into the hip socket, putting strain on the pelvic joints and causing pain and discomfort.⁸ 

Muscular imbalances

Weakness or tightness in specific muscles can cause overpronation. For example, the gluteus medius is a muscle located on the outer surface of the pelvis and is one of the main hip abductor muscles, providing stability of the hip, thigh and knee. When this muscle is weak, it can cause overpronation.¹¹ Additionally, having tight calf muscles can cause overpronation due to the tightness causing restricted movement during the gait cycle.¹² Overpronation can be prevented by strengthening certain muscles and performing stretching exercises to loosen tight muscles. 

Impact of muscle imbalances on foot mechanics

Imbalances in muscles in the feet, legs, and core can affect gait and posture, which can lead to compensatory movements such as overpronation. Postural deviations (when the spine is not neutral) can also cause someone to change the way they walk, potentially leading to overpronation.¹³ 

Lifestyle factors 

Several lifestyle factors can also increase the chance of overpronation. These are usually things that put extra pressure on our feet, such as being overweight, pregnancy, or excessive running or walking on hard surfaces^[2]. If you are overweight or obese, it is advised that you try to lose weight to ease the pressure on your feet. Not only will this help with overpronation, it will help to prevent any other strain or injuries to the feet, knees, and hips. During pregnancy, the natural weight gain and change to the centre of gravity can change a woman’s weight-bearing stance and create extra pressure on the knees and feet.¹⁴ Running or walking for long periods on hard surfaces puts a lot of pressure on the feet, as well as all of the joints in the lower body, due to the harsh impact of the foot striking the ground. Sometimes, our bodies attempt to combat this by trying to absorb more of the shock by overcompensating with overpronation. To prevent this, refrain from running on hard surfaces for extended periods. Try to run on softer surfaces such as grass or mud. 

Prevention and treatment

Fortunately, there are many ways to prevent overpronation and its associated side effects. If you do suffer from overpronation and have not been able to prevent it, there are also methods to treat the symptoms. 

Proper footwear

If you think you are an overpronator, it is vital to choose shoes with appropriate arch support, especially running shoes if you run regularly. It is a good idea to have both feet measured and to visit a running shoe shop for a gait analysis and suggestions for the most appropriate shoes. Many shoes now come with additional padding/support on the inner side of the sole to help with overpronation.

Stability and motion control shoes are also a good idea if you are a regular runner or are very overweight. Stability shoes are designed for people who overpronate, with extra support for the arch, midsole, and heel. They are more rigid than normal running shoes. Motion control shoes are designed to support heavy weight, flat feet, and severe overpronation. These shoes have extra support for the arch and midsole and have in-built heel cups (extra padding under the heel) for heel support. Motion control shoes prevent the foot from rolling too far inwards; therefore, they are stiffer and heavier than normal shoes and stability shoes.¹⁵ 

Orthotic inserts

Orthotic inserts are specially designed insoles that go in your shoes to correct foot problems and keep your feet in the correct position when walking or running. They support the ligaments of the lower body, which helps prevent injury and reduce foot pain. These can either be custom-made to suit your feet or can be bought pre-made from many fitness shops, health shops, pharmacies, and even supermarkets. Orthotic inserts for overpronation have extra support for flat feet and fallen arches to help correct your gait and posture, minimising the risk of pain and injury from overpronation.¹⁶ 

Orthotics are an easy and affordable solution to try if you suffer from overpronation and foot pain when running, walking, or standing. One pair can be swapped to different pairs of shoes, and they are not visible. Sometimes, they may make your shoes feel too tight, so it is a good idea to take them with you to try when buying new shoes. 

Orthotics need to be worn gradually during low-impact activities such as a short walk or just around the house. You may experience muscle aches at first as your body adjusts to the new foot position. If the orthotics cause pain, increase existing pain, or give you blisters, you should stop using them and contact your doctor for advice. 

Strengthening exercises

You can strengthen your foot arches with certain exercises, such as picking up marbles with your toes and walking on the outer edge of your feet. Another exercise which also helps to massage the arch at the same time is rolling a tennis ball under your foot. This should be done for 2-3 minutes per foot and repeated 3 times for each foot.¹⁷ 

Heel stretches are a good exercise to strengthen the Achilles tendon, which can help to improve pronation and help correct your gait. To do this stretch, stand with one foot in front of the other with the front leg bent and the back leg straight. Ensure all your body weight is on your front leg, and you should feel the stretch on your Achilles of the back foot. Do this 4 times each side, for 30 seconds each time.¹⁷ 

It is also easy to incorporate strengthening exercises into a regular fitness routine. Calf raises are a great exercise to strengthen the calf and ankle, which can reduce the risk of overpronation. Most gyms will have a calf raises machine, or this exercise can easily be done at home by standing with your feet flat on the ground or with your toes and balls of the feet on the edge of a step, with your heels hanging off. Other common exercises to include in a regular fitness routine to help with overpronation include clamshell exercises, which help to strengthen leg and hip muscles, which will help compensate for overpronation, and toe raises, which help strengthen the feet and improve your balance.¹⁷ 

You can increase the intensity of these exercises by adding weights or a resistance band. 

Seeking professional guidance

If overpronation has a significant impact on your life, it is advisable to see a podiatrist. It is important to get a professional assessment to confirm what is causing your symptoms. Podiatrists can create specific treatment plans based on your individual needs. For example, they may show you specific exercises you can do to ease pain and strengthen certain muscles.

Summary

Overpronation is a condition where the foot rolls too far inwards during walking or running. This can lead to stress on foot arches, ligaments, and muscles and increases the risk of injuries such as shin splints and plantar fasciitis. Overpronation can be caused by genetic factors such as flat feet or muscular imbalances or by lifestyle factors such as being overweight or excessively running on hard surfaces. Observing footwear wear patterns and a professional gait analysis can help identify overpronation. The effects of overpronation can extend beyond the foot, impacting the alignment of the lower body and potentially causing knee, hip, and lower back problems. Prevention and treatment strategies involve corrective footwear, orthotic inserts and strengthening exercises. Professional guidance, such as consultation from a podiatrist, is important for accurate assessment and for the creation of personalised treatment plans to help maintain overall foot health.