Supination (also called underpronation) happens when the foot does not roll inward sufficiently after it lands on the ground. Consequently, the force of the impact is concentrated on the outer side of the foot. Supination is especially problematic where the foot is continually striking the ground with some force, such as in running, hiking, and various other athletic activities. Unfortunately, habitual underpronation can lead to a whole host of other problems.

What Causes Supination?

Underpronation of the foot may be 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.

How to Tell if You Supinate

If you are underpronating, there are some giveaway signs, described as follows:

  1. Your Shoe Leans Noticeably to One Side – Place a shoe on a flat surface. If its 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 even worse as the shoe will provide less shock absorption on the worn side.
  2. 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 on the lower leg.
  3. You’re Getting Shin Pain – Because a supinated foot is less shock absorbent, 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. If you find yourself regularly dealing with shin splints, here are some exercises that can help.
  4. 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, Achilles tendons and calf muscles that are tight may cause supination or make it worse.
  5. 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 that is characterized by a deep ache or stabbing pain in the heel and/or along the arch of the foot. However, plantar fasciitis is a common condition and can be caused by factors other than supination.

Different Degrees of Supination

Supinated feet that are “flexible” can be corrected fairly easily, whereas supinated feet that are “rigid” are (as the name implies) much harder to fix. The degree of supination may be genetic or it may be a factor of age. People can start out with flexible supination, but with aging, their bones become more arthritic leading to more rigid supination.

Can Underpronation be Treated?

Once you have been correctly diagnosed as being a supinator, there are several things you can do to help alleviate the condition and its related issues:

  • Strength Training: Focus on hip and glute strengthening exercises to improve the stability of your ankles and feet.
  • Stretching: Regular stretching of your calves, Achilles, shins, and ankles before and after exercise such as running is especially important for supinators.
  • Wear the Right Footwear: You need to wear shoes with extra cushioning that allow your feet to pronate more. Stores that specialize in athletic footwear can advise you on the best shoes for underpronation. And, replace your shoes before they become significantly worn down on the outer side.
  • Consider 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.

How Rocky Mountain Foot & Ankle can Help

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 if you are indeed suffering from supination, and, if so, how severe your supination is. Whether it turns out that you have supination or not, once you have been accurately diagnosed, we can then plan the best course of treatment for your specific issues. Don’t spend any more time asking yourself if you underpronate – come to us and find out.

Dr. Roman Burk Podiatrist

Dr. Roman Burk Podiatrist

Dr. Roman Burk is a podiatrist at Rocky Mountain Foot and Ankle. He completed his Doctor of Podiatric Medicine degree from Temple University in Philadelphia, Pennsylvania in 2004. Dr. Burk is accepting new patients.

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