Ask any new medical student and they’ll tell you that learning the language
of medicine is a tough job. As a young doctor, they soon come to learn that it’s
essential for doctors to have descriptive terms to use when diagnosing and
communicating with peers and patients. Foot care is by no means exempt from
needing a language to describe how the foot and ankle work. Two of the most
common biomechanical terms used in foot care are pronation and supination.
Pronation is a term used to describe the arch of the foot becoming flat. A pronated foot is simply a flat foot. To pronate
is the verb form of the word pronation and means that the foot is rolling in or flattening.
Supination, on the other hand, refers to a foot that is rolling out and creating an arch. A supinated foot is simply a high arched foot. You can try this yourself.
Put your foot on the floor, and keeping the sole of your foot on the floor, roll the foot from the inside to the outside. There you go. Now you’re pronating and supinating.
Is a pronated foot a bad thing? Contrary to popular belief, a pronated of
flatfoot isn't necessarily a bad thing. A foot that is mildly pronated may work for a lifetime without symptoms.
On the other hand, a rigid, very pronated foot may indicate several different
foot problems. Rigid, pronated feet in young adults may indicate a
tarsal coalition. In older adults, a pronated foot may be due to a
tendon rupture of the medial arch.
Pronated feet may be rigid or flexible. Most children who show signs of
pronation have a flexible flatfoot. Rigidity of a flatfoot is typically
acquired. Supinated feet, on the other hand, are usually rigid and stiff. The
problems associated with a high arch in a supinated foot can be difficult to treat when foot problems
Once the terms pronation and supination are understood, they become an effective way to communicate with others regarding foot problems.
For example, you can use this knowledge when you go to the shoe store to shop for shoes. You know the feeling; you walk into the running store and there, facing you are dozens of shoes with bells and whistles like air bladders and springs.
What's the best shoe for you? Now that you know about pronation and supination,
you've become a smarter shopper. Here's why. Most pronated feet will loose the normal curvature of the foot from the heel to the toe, while supinated feet will increase in curvature. When I say curvature, think of the footprint you'd make when you get out of the pool. Is it straight or curved? When shopping for
shoes, and particularly when shopping for running shoes, this is important due to the fact that shoes come in different types of lasts. The last defines the curvature of the bottom of the foot. So a pronated foot requires a straight last shoe while a supinated foot requires a curved last shoe. Shopping for shoes can become much easier once you’re familiar with these two terms.
Treatment of Pronation
The most common complaint associated with pronation is foot fatigue. A
pronated foot is biomechanically less efficient than a foot that has the ability
to form an arch with each step. Foot fatigue due to pronation can be
managed in a number of ways. Knowing that most cases of pronation are due
to equinus, effort should be made to
address equinus stretching the calf muscle
each and every day. Also, try to avoid going bare foot or using shoes with
a low heel. Use of a heel lift can
significantly improve foot fatigue by weakening the force of equinus. If
the pronated foot is flexible, a firm
orthotic or carbon graphite orthotic
can be helpful. If the pronated foot is semi-rigid to rigid, a
support would be most appropriate.
Most cases of pronation in children are flexible. Therefore, the use of
a rigid insert like a UCBL or
Whitman orthotic can be helpful.