Pronation has had quite a career.
A perfectly normal movement of the foot somehow became one of the most worrying words in running.
You step onto a treadmill.
Somebody films your ankles.
The video slows down.
"There. You're pronating."
Cue dramatic music.
Except you are supposed to pronate.
The useful question is not simply whether your foot pronates.
It is whether anything about your movement, symptoms, history or footwear suggests that it actually matters.
The highlights
- Pronation is a normal movement that helps the foot adapt as it accepts load.
- "Overpronation" is a broad term rather than a single universally agreed diagnosis.
- Foot posture and dynamic foot movement are related, but they are not the same thing.
- Research does not support treating pronation alone as a strong universal predictor of running injury.
- Some runners may still find stability or motion-control shoes useful.
- If you are pain-free and comfortable in your current shoes, seeing your ankle move inward is not in itself a reason to change everything.
What is pronation?
When your foot meets the ground, it does not behave like a solid block.
Bones and joints move.
The arch changes.
The foot adapts to the surface and load.
Pronation describes a combination of movements that occurs as part of this process.
From behind, one of the easiest things to notice is the inward roll around the ankle as the foot accepts weight. That is only one visible part of a movement happening in three dimensions.
That visible movement is why pronation attracts so much attention in shoe shops.
But the movement itself is normal.
What is supination?
Supination is the movement in the opposite direction.
As you prepare to push away from the ground, the foot generally becomes relatively stiffer, although the timing and amount of movement vary between runners.
Running therefore involves movement through both pronation and supination.
Neither word means good or bad.
They describe movement.
So what is overpronation?
This is where things get fuzzy.
"Overpronation" is commonly used to describe a foot that appears to pronate more, faster or for longer than expected.
The difficulty is the word over.
Over compared with what?
There is no single simple degree of inward movement at which an otherwise healthy runner suddenly becomes an overpronator.
Different assessment methods can also classify feet differently.
A static assessment of somebody standing on the floor is not identical to watching that person run.
And a person's movement can change with:
- speed
- surface
- fatigue
- footwear
- strength
- previous injury
So treat "overpronation" as a description that may need context, not a diagnosis.
Does having flat feet mean you overpronate?
Not automatically.
Foot posture while standing and foot movement while running are not identical.
Research does show some relationship between foot posture and certain aspects of running biomechanics, but the relationship is not strong enough to predict everything about how somebody will run.[1]
Somebody with a lower arch may move quite differently from another runner whose feet look similar while standing.
That is another reason not to prescribe shoes simply by looking at an arch.
Does pronation cause running injuries?
This is where the old story starts to unravel.
Pronation has historically been blamed for a remarkably long list of running problems.
Shin splints.
Knee pain.
Achilles problems.
Plantar fasciitis.
Almost anything between the foot and hip has probably been blamed on pronation at some point.
The evidence is much less dramatic.
A systematic review covering 6,228 participants found evidence that pronated foot posture was associated with the development of medial tibial stress syndrome, commonly called shin splints, but the effect was small.
There was much weaker evidence of a small association with patellofemoral pain.
For the other injury groups examined, researchers found no clear relationship.[2]
A separate review looking at dynamic foot function also found limited and inconsistent evidence linking foot movement with different running injuries.[3]
So pronation may contribute to risk in some contexts.
It is not a universal explanation for why runners get injured.
A fascinating study of 927 new runners
One particularly useful prospective study followed 927 novice runners for a year.
Researchers classified their feet from highly supinated through to highly pronated.
Everyone then ran in the same type of neutral shoe.
If the traditional model were completely correct, you might expect the pronated runners to be injured much sooner.
They were not.
After 250 km of running, the researchers found no significant increase in injury risk for feet classed as pronated compared with those classed as neutral. Only 18 feet were classed as highly pronated, so the study could not settle the question for that smaller group.[4]
That does not mean pronation never matters.
It means:
pronation alone is not enough information.
So why do stability shoes exist?
Because changing shoe construction can influence movement, loading and comfort.
A stability or motion-control shoe may use geometry, foam shape, sidewalls or other design features to alter the way the foot moves through the shoe.
These designs have changed considerably.
Older motion-control shoes often relied on obvious dense posts under the inside of the foot.
Modern stability shoes can achieve support much more subtly.
And there is research suggesting these shoes may benefit some runners.
The evidence for motion-control shoes
A randomised trial followed 372 recreational runners using either standard or motion-control shoes.
The motion-control group experienced a lower overall injury risk.
When the researchers analysed runners by foot posture, the strongest apparent benefit was among runners with pronated feet.[5]
A later secondary analysis of the same trial found a lower risk of injuries the researchers classified as pronation-related among runners using the motion-control shoes. This was another look at the same runners, rather than a separate trial confirming the result.[6]
Those findings are important.
But they do not restore the old rule:
pronation = mandatory stability shoe.
The trial tested specific shoes in a specific population.
The subgroup analyses were smaller.
Footwear designs vary enormously.
A 2022 Cochrane review judged the overall evidence comparing motion-control with neutral or cushioned shoes to be very uncertain. It also found that choosing shoes by static foot posture probably made little or no difference to injury rates in military recruits. Those findings do not cover every shoe-fitting approach or every runner, but they do argue against confident promises of injury prevention.[7]
What it does tell us is that it would be equally silly to claim:
stability shoes never help anybody.
Should you buy stability shoes if you pronate?
Maybe.
Try answering these questions instead.
Are you currently comfortable and pain-free in neutral shoes?
If yes, you do not need to create a problem because of a treadmill video.
Have you consistently preferred the feel of supportive shoes?
That is useful information.
Have you repeatedly experienced similar running problems?
That may justify a more detailed assessment.
Does a stability shoe genuinely feel better when you run in it?
Good. Comfort is allowed to matter.
Has a healthcare professional recommended a particular feature as part of managing a specific problem?
That is different from a generic retail label.
Can a neutral runner wear stability shoes?
Shoe categories are not prescriptions.
A runner does not need a certificate proving she pronates before she is allowed to wear a supportive shoe.
Likewise, somebody classified as pronated is not banned from neutral trainers.
The boundary between modern neutral and stability shoes is becoming increasingly blurred anyway.
Try the shoes.
Run in them.
Pay attention to comfort and how they feel.
What about wear patterns on the bottom of your trainers?
They can tell you where rubber has worn away.
They do not provide a complete biomechanical diagnosis.
An outsole may wear differently because of:
- foot strike
- surface
- shoe construction
- running speed
- how long you've owned it
- asymmetry
- where the rubber was placed in the first place
Interesting?
Yes.
Enough to diagnose overpronation?
No.
What if you really do pronate a lot?
If you have no pain, it may simply be how you move.
If you have persistent or recurring problems, greater pronation may be one piece of useful information.
That is where a clinician can consider it alongside everything else.
The question becomes:
Does this movement appear relevant to this person's symptoms?
rather than:
Can we make this foot look more neutral?
Those are not the same goal.
Don't deliberately change your running because of one word
Another common reaction to being told you overpronate is to try to hold your foot differently.
Please don't spend your next five miles consciously trying to keep your ankle upright.
Running is a complex automated movement.
Gait changes can sometimes be useful therapeutically, but they should have a purpose and usually need progression and feedback.
Trying to manually control every foot strike is unlikely to make your Sunday run more enjoyable.
The Running Woman verdict
Pronation is normal.
Some runners pronate more than others.
That variation may be relevant to certain injuries and to how some people respond to particular shoes.
But your foot moving inward does not automatically mean something is broken.
If you're comfortable, running happily and injury-free, you do not need to be frightened by a slow-motion video of your ankle.
And if something does hurt, let's investigate the actual problem rather than blaming one movement before we've even said hello.
Love RW x
General information only. Persistent or recurrent running-related pain should be assessed by an appropriately qualified healthcare professional.
More from Running Woman
- How to choose running shoes
- What gait analysis can tell you
- How running shoes should fit
- Explore Kit advice
Sources and further reading
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Hollander K et al. (2019). The relationship between static and dynamic foot posture and running biomechanics: A systematic review and meta-analysis. Gait & Posture, 72, 109-122. DOI: 10.1016/j.gaitpost.2019.05.031. Back
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Neal BS et al. (2014). Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 7, 55. DOI: 10.1186/s13047-014-0055-4. Back
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Dowling GJ et al. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot and Ankle Research, 7, 53. DOI: 10.1186/s13047-014-0053-6. Back
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Nielsen RO et al. (2014). Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British Journal of Sports Medicine, 48(6), 440-447. Back
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Malisoux L et al. (2016). Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. British Journal of Sports Medicine, 50(8), 481-487. DOI: 10.1136/bjsports-2015-095031. Back
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Willems TM et al. (2021). Motion-Control Shoes Reduce the Risk of Pronation-Related Pathologies in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy, 51(3), 135-143. Back
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Relph N et al. (2022). Running shoes for preventing lower limb running injuries in adults. Cochrane Database of Systematic Reviews, 8, CD013368. DOI: 10.1002/14651858.CD013368.pub2. Back
