Concerned I Pronate When Running

Ask the Experts: Dr Steve Gangemi is a highly respected expert in this field, look him up "The Sock Doc"

Should I Be Concerned That I Pronate When I Run?

August 2011

I have been to three different shoe stores here in the Bay Area, and each store
person took a look at my current running shoes (I wear them during the day) and
said that I pronate.” One youngish guy (he had the look of an emaciated, longdistance
college runner) wanted to sell me some “anti-pronation”, “motion-control”
shoes and a pair of off-the-shelf orthotics. I politely declined his offer and later mulled
my options at a nearby Starbucks. I am still kicking tires, and it seems that the
minimalist shoe trend is less about the perils of pronation and more about the horrors
of heel-striking. So, inquiring minds (and feet) want to know: what is the straight story
about pronation?

by Dr. Steve Gangemi (aka Sock Doc)...

Pronation has gotten a bad rap.This has been going on for years. But it makes little
sense to point an accusing finger at pronation as the “cause” of many running
injuries.
We all pronate.
During a normal gait cycle the foot rolls inwards, everts (turns out on its axis), and
the arch flattens. This is pronation and the foot is very flexible and loose at this time,
or should be. Then the foot becomes more rigid and turns outwards a bit and uses
stored energy in the tendons and ligaments to push off the ground, hopefully as it is
rolling over the big toe. This is supination. Any variation to this normal cycle of
function can result in a problem.
These terms are often used interchangeably to diagnose why someone has a foot
problem or injury. What about overpronation? The reality is that it’s a symptom of a
problem and may correlate with an injury somewhere in the body or be the result of
overtraining. Overpronation (or lack of supination) as with most symptoms, is often
treated improperly as the root cause of a problem, especially by those eager to sell
runners orthotics or “anti-pronation” shoes.
Foot pronation is a necessary and important aspect of the gait cycle. It acts as a
major shock absorber for forces that are applied to the foot. During pronation, the
tibialis anterior and the tibialis posterior muscles are active in supporting the foot,
especially the main arch. If there are imbalances in the lower leg muscles,
particularly the tibialis posterior, then excessive pronation may result, or the failure to
resupinate.
Artificially reducing normal pronation with orthotics and many types of rigid footwear
decreases the foot’s ability to act as a shock absorber and adapt to the ground
underneath. This can result in stress and injury to the foot and other areas of the
body responsible for normal gait action – and that can even mean an opposing upper
body limb whose natural movement is necessary during a normal gait cycle. That
means if you don’t pronate and supinate correctly, you may end up with a shoulder
problem, for example. In such a case, orthotics or motion-control footwear can now
become the reason for a new injury as normal gait is disrupted and shock is
artificially altered.
How do you know if you really overpronate? There are a few things you can do as a
self test. First, look at the shoes you’ve been walking or running in for some time. If
the outside of the heels are excessively worn out, then that is a sure sign you
overpronate. Another test is to point your foot down as much as possible (plantar
flexion) and then inwards. So point down and twist your foot inwards like you’re
trying to point down to the ground with your big toe. If this causes some discomfort
on the inside of your calf muscle, especially behind your tibia bone (the main bone of
your lower leg), or in the arch of your foot, you may have excessive pronation. This
movement is actually one of supination, but many people have a weakness in
supination and therefore they excessively pronate. There is an imbalance between
the two. A third thing to observe is how you stand. If you catch yourself standing on
the outside of your feet (rolling one or both of your feet outwards while standing),
then that is a sign that you overpronate. One last test you can do is have someone
look at your Achilles Tendon. Normally the tendon should run straight down the leg
into the heel. If the foot is overpronated, it will turn inwards.
If you overpronate what do you do? Don’t treat it directly because you are merely
treating the symptoms and controlling your pronation will just land you another
problem eventually. Many runners are told they overpronate because their
podiastrist diagnosed it or some guy at the local running shoe store told them so
while recommending some trendy motion-control shoes.
You’re not going fix your overpronation with any orthotic, supporting
footwear,stretching, or any other gimmick out there. Always look for the source, and
since these common treatment regimens only treat the symptom, as overpronation is
just that – a symptom – look to why you are not pronating correctly.
Muscle imbalances of the lower leg and foot are the main reason for improper
pronation (and supination). Wearing over-supportive shoes and/or orthotics will
throw your body out of whack. Trying to control pronation and supination directly will
only disrupt normal gait, balance, proprioception, and muscle response resulting in a
new injury somewhere down the line. Correcting these muscle imbalances can be as
simple as transitioning out of your orthotics or non-minimalist shoes to minimalist
shoes and walking barefoot as much as comfortably possibly so your foot and leg
muscles, and tendons and ligaments begin to strengthen and heal.
Another significant and perhaps more common reason for muscle imbalances
resulting in pronation/supination problems is overtraining. Yup, too much stress will
have a dramatic effect on the lower leg muscles, particularly the tibialis posterior
muscle that supports the main arch of the foot. There is a common connection
between this muscle and the adrenal glands, which is where the major stress
hormone cortisol is produced. So high levels of stress result in high levels of cortisol
and tibialis posterior problems and then overpronation. Shin splints and plantar
fasciitis are two common injuries that accompany this problem too. Another adrenal
gland hormone, aldosterone, is necessary for sodium regulation and electrolyte
balance in the body.
If you’re training too hard and anaerobic too much then you’ll end up with cortisol
and aldosterone problems, and you will overpronate as a result. So, chill out on the
hard-core stuff for a bit, go back to more aerobic training, walk barefoot as much as
possible, and get out of those over-supportive running shoes.