Pronation and supination are two words runners commonly hear when they are looking for running shoes. Very simply, pronation is when the foot rolls towards its inside edge and supination is when the foot rolls towards its outer edge. Both movements are required for normal foot mobility during running. Problems arise when we see too much or too little of these movements.
Excessive supination is a relatively rare occurrence with approximately 1-2% of runners making up this group. Usually these people have high arches, rigid feet and demonstrate a wear pattern along the outer edge of their shoes from the heel to the forefoot. Because of foot stiffness and lack of shock absorption, this group is at a relatively higher risk for stress fractures and injuries such as ankle sprains and iliotibial band problems. Runners with supination issues should have shoes that are flexible with good cushioning to reduce shock transfer to the rest of the body.
Overpronaters tend to make up approximately 80% of runners and can range from mild to severe. This group is characterized by arches that are flatter than normal, hyper mobile feet, and demonstrate an excessive wear pattern on the outer edge of the heel. Because of the lack of stability from overpronation, these runners are more succeptible to soft tissue injuries and medial knee problems. Runners with overpronation problems require shoes that are somewhat rigid with devices to control the speed and/or degree of pronation that reduces stress to the rest of the body. Mild overpronation can typically find a good result with stability shoes while severe overpronators should move up to motion control shoes.
What about the scenario where a runner has one foot that is different from the other foot? For example, one foot supinates and the other pronates. This is where custom-made orthotics are recommended. Here you can get one orthotic designed to reduce the stress of supination and the other for pronation. These are generally used in combination with a neutral shoe.
You may also have a situation where the amount of pronation varies from foot to foot. This, too, is an ideal situation for orthotic use. The type of shoe used in this case is not so clear-cut and may range from a neutral to a motion control shoe depending on the type of orthotics, degree of pronation, and weight of the runner.
As for what type of orthotics are preferable, this is somewhat controversial and will be the topic for next month’s article.