Pronation: Cause and effect.

Pronation: Cause and effect.

Pronation is an inward turning of the ankle that takes place when a person runs or walks. The drawing below is of a person’s right foot.
pronated foot

You can see how the foot drops inward- that is pronation. The biggest misconception I come across, is people showing me their work shoes and how the shoe has worn down on the outside of the heel. Many believe that this is a sign that they supernate or roll the foot outward as they run. In fact, this just means that you hit the outside of your heel as your foot lands on the ground. Pronation happens as your body crosses over your center of gravity.


Flat Foot Arches (although not necessarily)

A lot of runners have been taught that people with lower foot arches pronate. In order to test for this, they advise that you wet your feet and then stand on paper. A larger wet surface area implies a lower foot arch and a smaller wet pattern implies a higher foot arch.  There is an easier way to do this: simply look at the foot arch! The misconception goes as follows: low foot arch = pronation. That is just not true.

I have come across many runners with flat foot arches who do not pronate, and runners who have high foot arches that do pronate.

A Weakness in the Subtalar Joint:

Have a look at the x-ray.pronation x ray You can see the talas bone and under that a small joint.A weakness in this joint responds well to an antipronator. Your foot will be supported as the joint allows  too much movement.

There are exercises that you can do to strengthen the medial (inside) muscles of the lower leg. A stronger tibialis posterior will help reduce levels of pronation if there is too much movement through this area.

Weakness in the Gluteus Medius Muscles:

Weakness in the Glut Medius muscle will place all sorts of strain on the runner. This weakness causes the runner’s unsupported hip to drop, which in turn causes the weight bearing leg to move under the runner for better balance, thereby placing the foot in a pronated position.

I have found in such cases that the runner will benefit from an anti-pronation running shoe. With proper Glute Medius strengthening exercises, it might be possible to move the runner into a neutral shoe in due course. Read more about that here – Weak Glute Medius Muscles.


The body works as a whole. Injure your baby toe, and see how your legs, hips, back and shoulders take strain.pronation skeleton

Excessive pronation can exacerbate:

  1. Plantar fasciitis. This shows up as pain under the foot arch.
  2. Pain under the inside malleolus. Your malleolus is the ‘ankle’ bump on either side of your lower leg.
  3. Achilles and calf issues. The heel bone/calcaneus dropping inward will place an uneven strain on the Achilles tendon which will continue up into the calf.
  4. Knee pain. Look down at one of your legs. Now roll the inside of your foot down wards. As you do this will see the entire knee rolling inwards, and the knee losing its straight tracking line. This can lead to a condition known as patella femoral pain syndrome.
  5. Hip pain. As your leg rotates inward during pronation, you will notice that your upper trochanter rolls in as well, placing strain on the side section of the hip (glute medius).
  6. Once the hips have been compromised, lower back pain is sure to follow.
  7. Left unchecked, the trapezius muscles leading up into the shoulders will also start getting tired.

Closing points

The worst mistake you can make as a runner is to get labeled as either a neutral runner or a pronator. Some pronate heavily, others mildly. In the same way, running shoes differ in the amount of stability they provide. A Brooks Ravenna will be very different to an Asics GT2000. Both are great shoes, provided they are placed on the right runner.

Avoid anti pronators if you don’t pronate. They can cause all sorts of foot, knee and hip issues.

You should be regularly assessed as things change, more often for the good as you run more, but sometimes they can also get worse.

Give us a call if you want us to fit you with a pair of running shoes. We will get you on the treadmill, film you and analyse the video.


Mike Roscoe.

Mike Roscoe


About sbrsport

SBR Sport specialises in Swimming, Biking and Running. On the medical side we are able to do intensive bike setups, leg assessments and soft tissue release. - and/or facebook -
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4 Responses to Pronation: Cause and effect.

  1. Pingback: How to buy shoes from SBR Sport. | SBR Sport

  2. Theresa Pio says:

    Hi Mark,

    In short, my daughter’s a swimmer, she prefers long distances, however we’ve noticed that her upper back “hunches” so much to the extent that when ask her to sit up “straight”, she finds it difficult to do so (and to keep it that way). Although she trains hard, she’s has now reached a plato, she does NTS Age Group swimming, however been battling to up until now, to reach any Level 2 times. We’re not pressuring her at all, however, I am very worried about her posture which seems to be getting worse as she gets older, she’s 14 now, turning 15 in August. We live in Moreleta Park in Pretoria. Would you be able to refer me to someone in our near vicinity in would be able to guide and give advice?

    • sbrsport says:

      Hi Theresa – I am not aware of people who work in that area. It might be an idea to see a chiropractor. Give us a call if you don’t come right.

  3. Pingback: The Fibularis and Tibialis Posterior Muscles: The more you Know the better. | SBR Sport.

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