When it comes to foot biomechanics in general (and pronation problems in particular), overpronation tends to get all the press. That’s not really surprising, of course, since overpronation is extremely common. A lot of us have feet that roll too far inward after they land on the ground; by some estimates, this includes more than half the population!
However, supination or underpronation—the opposite situation, where the foot doesn’t roll inward enough after landing—can be an even bigger issue. Supination is especially problematic when the foot repeatedly strikes the ground with force, such as in running, hiking, and many other athletic activities.
Unfortunately, habitual supination can lead to a whole host of other problems. And since it isn’t as common as overpronation, you might be less likely to realize you even have it.
What Causes Supination?
Underpronation of the foot is often, although not always, the result of having a foot with a naturally high arch. It can also be the outcome of weakness in certain muscles in the calves, ankles, or feet caused by an improper gait. Previous injuries or shoes that don’t fit properly may also play a part.
In most cases, genetics plays a significant role in whether someone supinates. Other contributing causes may include bad footwear, previous injuries, neuromuscular conditions, and more.
As with overpronation, supination/underpronation can range from mild to severe. Additionally, some supinated feet are more “flexible,” while others are much more rigid. As you might expect, flexible supination tends to be easier to correct. In any case, early treatment is essential, since people can start out with flexible supination but gradually develop a more rigid, arthritic condition over time.
How to Tell if You Supinate
The best way to determine your pronation style is to come to our office and get a gait analysis. A professional evaluation will give you better information about not only whether you supinate, but also the degree to which you supinate, what’s causing it, and how to treat it.
That being said, you can definitely look for some clues at home if you suspect that you supinate. Here are five of the biggest giveaways:
Your Shoe Leans Noticeably to One Side
Place a well-worn shoe on a flat surface. If it tilts outward, you are most likely supinating. If the shoe is noticeably broken down on its outer side, continued wear is likely to make underpronation pain even worse, as the shoe will provide less shock absorption on the worn side.
If you don’t have an especially well worn shoe right now, you can still check the tread patterns. If the tread is noticeably more worn down on the outside than on the inside, supination is likely.
You’re Having Foot and/or Ankle Problems
The extra pressure on the outside of the foot caused by underpronation can also decrease the stability of your ankle and increase the likelihood that you will roll or sprain it. In addition, stress fractures can occur in the fourth and/or fifth metatarsal bones that are connected to your fourth and pinky toes.
Less commonly, supinators may also experience stress fractures in the fibula, the outside bone (thigh bone) on the lower leg.
You’re Getting Shin Pain
Because a supinated foot is generally less able to absorb impact shocks than one with neutral pronation, over time a type of lower leg pain known as shin splints may result. Shin splints happen on the front part of the leg below the knee either on the outside (anterior shin splints) or the inside of the leg (medial shin splints). Supinators place most of their weight on the outer part of the foot, so they are more likely to suffer from anterior shin splints.
You Have a Super Tight Calf and Achilles
This is somewhat of a “chicken and egg” issue. Individuals with tight Achilles tendons and calf muscles tend to be supinators because the extra stress placed on the outside of the foot can radiate upward and contract tendons and muscles. Conversely, tight Achilles tendons and calf muscles may cause supination or make it worse.
You Have Stabbing Pain on the Underside of Your Foot
Underpronation can create extra strain on your plantar fascia, the ligament that connects your heel and toes. This strain can lead to a painful condition called plantar fasciitis, which is characterized by a deep ache or stabbing pain in the heel and/or along the arch of the foot.
That said, it’s important to remember that plantar fasciitis is a very common condition and can be caused by factors other than supination.
We Can Help You Eliminate Pain from Underpronation
An average person will not know whether underpronation is the underlying cause of their specific foot-related issues. One of our trained podiatrists will study your foot alignment and perform tests to diagnose whether you are indeed suffering from supination and, if so, how severe your supination is.
Once we know more about your pronation style, we may recommend treatment measures such as:
- Strength training: Hip and glute strengthening exercises can help improve the stability of your ankles and feet, reducing underpronation strain.
- Stretching: Regular stretching of your calves, Achilles, shins, and ankles before and after exercises such as running is especially important for supinators.
- Better footwear choices: Supinators need shoes with extra cushioning that allow their feet to pronate more. Stores that specialize in athletic footwear can advise you on the best shoes for underpronation. Also, don’t forget to replace your shoes before they become too worn down to support your feet anymore—this typically happens after about 250-400 miles logged.
- Orthotics: In general, orthotics are somewhat trickier to design for underpronators vs. overpronators. However, a custom-built orthotic could give some measure of correction and also provide cushioning and a comfortable surface area for your foot. Because of the challenges of choosing orthotics for supinators, we highly recommend you come to us first, rather than trying to pick something yourself at the pharmacy.
The bottom line, though, is that you don’t have to keep suffering from supination, and it doesn’t mean you can’t enjoy a healthy, active lifestyle! You just need to find a solution that works for your unique situation.