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reference presentation true The Foot and Ankle Knowledgebase, L.L.C., L.L.C., L.L.C. 2000 en-US Pronation | Causes and treatment options pronation,flat foot,flatfoot,flatfeet,bad arches,sore arches,shoes for pronation,orthotics for pronation,arch supports for pronation,pronated runner,pronation treatment,running shoes for pronated feet,pictures of a pronated foot,symptoms of pronation,what is pronation,pronation of the foot,pronation vs supination Pronation - learn about the onset, symptoms and treatment recommendations - part of the Foot and Ankle Knowledge Base.


-Wednesday, 13 January 2021
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Pronation is a term used to describe the arch of the foot becoming flat. A pronated foot is 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.


  • Foot fatigue
  • Arch pain
  • Many pronated feet are asymptomatic

DescriptionPronated foot

Contrary to popular belief, a pronated or flatfoot isn't necessarily a bad thing. A foot that is mildly pronated may function 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 posterior tibial tendon.

The development of the structure of the foot occurs with early weight bearing. The foot of the infant is soft and malleable. Load applied to the foot can influence the development of the foot during childhood, prior formation of the adult foot. Equinus is the term used to describe a limited range of motion at the ankle. In early walkers, if equinus is significant the foot will pronate to accommodate the equinus.  Equinus is the most common contributor to acquired pronated feet.

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 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 lose 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. 

Causes and contributing factors

Asymptomatic pronated feet may carry a person through a lifetime without problems. Contributing factors to pronation may include obesity, equinus, ligamentous laxity or congenital deformities such as Marfan's Syndrome.

Differential diagnosis

The differential diagnosis for pronation includes:

Posterior tibial tendon dysfunction
Tarsal coalition


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 by stretching the calf muscle each and every day.  Also, try to avoid going barefoot 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 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.

When to contact your doctor

Pronation is often asymptomatic. If you do experience pain or fatigue of the foot from pronation, a simple OTC arch support may decrease the pain. If you continue to have symptoms, consult your podiatrist or orthopedist for additional suggestions.


References are pending.

Author(s) and date

Dr. Jeffrey OsterThis article was written by medical advisor Jeffrey A. Oster, DPM.

Competing Interests - None

Cite this article as: Oster, Jeffrey. Pronation.

Most recent article update: January 14, 2021.

Creative Commons License  Pronation by is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.