Pronation is essentially a flattening of the feet with a rolling in (toward the other foot) of the ankle. Everyone pronates – it is a normal part of walking. When a foot and ankle pronate too much, however, it is called over-pronation, figure 1.
Figure 1 - Over-pronation
Checking Yourself for Over-pronation
You can test for too much pronation by looking at the leg and foot from
the back. In a normal foot, the Achilles tendon runs straight down the
leg into the heel. In a foot that is over-pronated the tendon will run
straight down the leg, but when it lies on the heel it will bend
outward. This makes the inner ankle bone much more prominent than the
outer ankle bone.
Because over-pronation involves a turning-in of the foot, all of the
muscles and tendons which run from the leg and ankle into the foot will
be twisted. If left untreated, pronation may be the cause of
Heel Pain,
Achilles tendonitis,
Posterior tibial tendonitis,
Shin splints, Tired feet,
Ankle sprains,
Bunions, Plantar fasciitis,
Hammertoes,
Metatarsalgia,
unstable ankles and even
knee, hip, and lower back pain.
What Causes Over-pronation?
By far the most common cause is simply hereditary. You can blame your
parents. The second most common cause is due to how your feet were
positioned in your mother’s womb. If this is the cause it is called a
congenital defect. In either instance, the following occurs in our feet
during our development:
• The muscles and ligaments which hold our bones together at the joints
become looser than normal.
• Since the bones are not held tightly in place, the joints are not
aligned properly, and the foot gradually turns outward at the ankle,
causing the inner ankle bone to appear more prominent.
• The foot moves in this direction because of gravity - it naturally
falls this direction. It is more difficult for the foot to move in the
opposite direction (called supination).
• As we grow, the muscles and ligaments adapt to this abnormal
alignment. By the time growth is complete, the pronated foot is
abnormally flexible and flat. When you walk on this type of foot
• Normal aging leads to further looseness of our muscles causing the
pronation to become worse.
What Happens Over Time to the Over-pronated Foot
• Because soft tissues are too loose to hold the bones together
properly, the bones of the feet shift.
• The muscles attached to these bones must also shift, or twist,
• The strongest and most important muscles which attach to our foot
bones come from our lower leg. So, as these muscles come down the leg
and across the ankle, they must twist to maintain their proper
attachments in the foot.
• This twisting of these muscles and flattening of the feet can cause
many problems including:
Heel Pain
Achilles tendonitis
Posterior tibial tendonitis
Shin splints
Tired feet
Ankle sprains
Bunions
Plantar fasciitis
Hammertoes
Metatarsalgia
Treatment of Over-pronation:
Children:
There are some studies that indicate that if excessive pronation is
treated before the age of five it can the bones and joints will be align
properly as the child grows. This will help prevent the arch from
collapsing, as well as allowing the muscles of the leg to enter the foot
without twisting. This may prevent some of the problems that pronation
causes.
Treatment for pronation in children may include prefabricated or
custom-made orthotics along with exercises. In general we try to use
prefabricated orthotics in young children since they tend to grow out of
orthotics rather quickly.
Treatment usually continue until the child has finished growing, and
then the adult may need to wear orthotics to prevent the pronation from
returning (the foot, as every other part of our body, tends to return to
its original form if preventive measures are not taken).
Adults:
In adults we use prefabricated or custom orthotics, depending on degree
of over-pronation and the problems the person is having. These
treatments are discussed on the pages in this website dealing with
specific foot and ankle problems. In addition, we recommend stable
shoes.
If you would like to be evaluated to find out if excessive pronation is
contributing to problems you might be having,
call today to make an appointment at our
Seattle foot and ankle clinic.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.
