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 do occur.

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 OTC orthotic or carbon graphite orthotic can be helpful.  If the pronated foot is semi-rigid to rigid, a flexible arch 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.

Pronation - derived from the Latin term pronus, meaning to move forward or to lay flat.  In foot care, pronation refers to the act of flattening the arch.

Prone - also derived from the Latin, pronus, to lay flat.  Typically refers to the body position of laying belly down.

Supine - derived from Latin, supinus, to look up or lie on the back.

Supintation - the act of moving up.  In foot care, supination refers to the action of creating an arch.

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The biomechanics of pronation can be quite complex and involve any number of joints within the foot.  The subtalar and midtarsal joints are primarily responsible for control of pronation and supination.

Not all pronated feet are symptomatic.  When symptomatic, the most common symptom of pronation is foot fatigue. 

The differential diagnosis and factors that contribute to pronation include;

Arthritis of the rearfoot and midfoot

Equinus

Flatfoot

Posterior tibial tendon dysfunction

Tarsal coalition

Traumatic injury of the posterior tibial tendon

• Flatfeet

• Posterior Tibial Tendon Dysfunction

• Supination

• CT Band Syndrome

• Arch Pain

This article was written by Jeffrey A. Oster, DPM and last updated 4/15/10. No additional information is available for this topic.