What is the problem with overpronation in runners?

The term "overpronation” is a frequently used and misused term by runners and health professionals in the framework of running injuries as well as the use of running footwear. Pronation is really a normal motion of the rearfoot in which the ankle tilts medially and the mid-foot of the foot flatten. This is exactly what the foot is meant to do as it is how the feet adapts to unequal surfaces and absorbs impacts. It is healthy and there is absolutely nothing wrong with it. The way some runners chat about what they have read about it, you would think they have some type of illness.

Where the problem occurs is that it is widely assumed to be a risk factor for an injury when running. Because of this, there are design characteristics in running shoes that are sold to assist runners with this overpronation. These are what are known as the motion running footwear. In contrast, the neutral running shoes don’t have these types of design features directed at helping the so-called too much pronation.

The issue with the concept of overpronation is that there isn’t a consensus on what is ‘normal’ and what is ‘over’. Many runners with significant overpronation get no problems and other runners with only small amounts get lots of complaints. The actual research linking overpronation to an overuse injury is not well supported. The agreement of the systematic reviews of the data is that it is only a very small risk factor, so it is not really a major problem  due to so many additional factors that go into runners getting an injury.

So should overpronation be treated? Yes, if it is bringing about the issue. No, if it is not contributing to the issue. This is often challenging to decide. A key in determining if it is causing the issue is to decide if the loads in the foot that it is causing are high enough to damage the tissues. The supination resistance test can be helpful here in helping decide this. If that assessment is higher, then the forces are high, so the overpronation should probably be dealt with. If the forces are low, then it may not be necessary to manage it.

If  it should be managed, then the reason for the overpronation needs to be dealt with. There is not a one-size-fits-all when it comes to overpronation. If a muscle weakness could be the reason for the problem, then exercises such as the short foot exercise should help (it won’t help other reasons). When restricted calf muscles are the issue, then  stretching is what is needed (muscles strengthening or foot supports will fail in these); when a bony alignment, for example forefoot varus, problem is the reason, then only foot orthotics are going to help (strengthening muscles and calf muscle stretching will not help); and so it continues. The reason has to be resolved.

There are numerous fallacies and junk being spread about overpronation. A key red flag is that whoever is talking or writing about overpronation is, if they advocate a one-site-fits-all when it comes to this, then they probably do not know what they are blogging about.

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