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.

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 PainAchilles tendonitisPosterior tibial tendonitisShin splints, Tired feet, Ankle sprainsBunionsPlantar fasciitisHammertoesMetatarsalgia,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
Plantar fasciitis

Treatment of Over Pronation:


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).


In adults we use prefabricated orthotics 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, contact us today to make an appointment at our Seattle foot and ankle clinic.

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