Pronation of the foot
Pronation or eversion is the inward roll of the foot while walking or running. Another way to look at pronation instead in terms of the degree of inward roll is in terms of where the foot pushes off at the end of each step, or at the end of the gait cycle.
There are three main types of pronation in human gait; neutral pronation, overpronation, and underpronation or supination. While both overpronation and supination occur while walking and standing, they are usually more pronounced and the effects amplified while running.
According to B. Hintermann, a doctor in the Orthopaedic Department at Kantonsspital in Basel, Switzerland, some pronation, also called eversion, is natural in the body’s regular movement. However, overpronation and underpronation (supination) can be potentially harmful. Neutral pronation occurs when the foot experiences a normal, healthy amount of pronation instead of overpronating or underpronating. In healthy movement more of the toe area will be used when pushing off than in unhealthy movement. In neutral pronation the weight distributes fairly evenly among all of the toes with a slight emphasis on the big toe and second toe which are better adapted to handle more of the load.
Those who overpronate tend to push off almost completely from the big toe and second toe. As a result, the shock from the foot’s impact doesn’t spread evenly throughout the foot and the ankle has trouble stabilizing the rest of the body. Additionally, an unnatural angle forms between the foot and ankle and the foot splays out abnormally. It is common even for people who pronate normally to have some angle between the foot and the ankle, but not to the extent seen in those who overpronate. In normal pronation the weight distributes evenly throughout the foot.
There are many possible causes for overpronation, but researchers have not yet determined one underlying cause. Hintermann states, “Compensatory overpronation may occur for anatomical reasons, such as a tibia vara of 10 degrees or more, forefoot varus, leg length discrepancy, ligamentous laxity, or because of muscular weakness or tightness in the gastrocnemius and soleus muscles." Pronation can be influenced by sources outside of the body as well. Shoes have been shown to significantly influence pronation. Hintermann states that the same person can have different amounts of pronation just by using different running shoes. “It is easily possible that the maximal ankle joint eversion movement is 31 degrees for one and 12 degrees for another running shoe."
There has been some speculation as to whether arch height has an effect on pronation. After conducting a study at the Rose-Hulman Institute of Technology, Maggie Boozer suggests that people with higher arches tend to pronate to a greater degree. However, the generally accepted view by professionals is that the most pronation is present in those with lower arch heights. To complicate matters, one study done by Hylton Menz at the University of Western Sydney-Macarthur suggests that the methods for measuring arch height and determining whether someone is “flat-footed” or “high-arched” are unreliable. He says, “For this reason, studies investigating the relationship between static arch height motion of the rearfoot have consistently found that such a classification system is a poor predictor of dynamic rearfoot function.”
Overpronation may have secondary effects on the lower legs, such as increased rotation of the tibia, which may result in lower leg or knee problems. Overpronation is usually associated with many overuse injuries in running including medial tibial stress syndrome, or shin splints, and knee pain Hintermann states, “Individuals with injuries typically have pronation movement that is about two to four degrees greater than that of those with no injuries.” He adds however, that between 40% and 50% of runners who overpronate do not have overuse injuries. This suggests that although pronation may have an effect on certain injuries, it is not the only factor influencing their development.
Wearing supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries that are thought to be associated with pronation. According to R.E. Arendse, a researcher at the Sports Science Institute of South Africa and the University of Cape Town, “75.5% of injured runners are successfully treated with the prescription of orthoses." In a study conducted by Gross, Davlin, and Evanski at Orthopaedic and Sports Medicine Associate, overpronation and injuries associated with it were the most common reason for diagnosing orthotics. 262 out of the 500 runners involved in the study either had great improvement or complete healing of the injury after wearing the orthotics. The most effective treatment of injuries came in treating symptoms that resulted from unusual biomechanics within the body such as overpronation. An added advantage of orthotics is that they often allow the runner to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming.
Roy Cheung, a graduate student, and Gabriel Ng, a professor and Associate Head of Department, both in the Department of Rehabilitation Sciences at the Hong Kong Polytechnic University, conducted a study showing that foot pronation tends to increase in runners as mileage also increases, potentially increasing the risk for injury. Motion control shoes are a specific type of running shoe designed to limit these excessive foot motions. They have been shown to significantly reduce the amount of plantar force (a force generated by excess pronation) when compared to normal footwear used in running. Motion control and stability shoes have increased medial support which may increase stability to the foot and leg and lower the amount of pronation in the foot.
Certain methods of taping the foot and leg have also been shown to be effective in preventing overpronation. In a study conducted at the University of Queensland, a taping procedure known as the LowDye taping technique was shown to be effective in controlling pronation during both movement and standing.
Specific patterns of lacing running shoes have also been shown to help reduce pronation. Marco Hagen, a researcher in the Biomechanics Laboratory at the University of Duisburg-Essen, concludes that, according to his study, when the highest number of eyelets in the shoe is used for lacing and the shoes are tied as tight as possible, pronation is significantly decreased.
Several studies have shown that running barefoot can decrease pronation on the foot’s impact with the ground. This is thought to be because running shoes have extra weight for cushioning at the heel of the shoe, causing the runner to heel-strike more, which in turn results in increased pronation during the step. According to Stacoff, Kaelin, and Steussi, researchers at the Biomechanics Laboratory of the Swiss Federal Institute of Technology, “The least amount of pronation takes place when running barefoot."
Supination occurs when the foot impacts the ground and there is not enough of an “inward roll” in the foot’s motion. The weight of the body isn’t transferred at all to the big toe, forcing the outside of the foot and the smaller toes which can't handle the stress as well to take the majority of the weight instead.
Runner’s World states, “[Underpronators] do best in a neutral-cushioned shoe that encourages a more natural foot motion." Since underpronators’ feet don’t roll inward like overpronators’, support isn’t necessarily needed to correct supination as it is to correct overpronation. Instead, extra cushioning in the shoe is the best way to correct underpronation.
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