The Pain Free Athlete :: Foot Alignment

Pronation is defined in the Merriam-Webster dictionary as “rotation of the medial bones in the midtarsal region of the foot inward and downward so that in walking the foot tends to come down on its inner margin.” You can see an image of pronation at the bottom of the following image.

Pronation is a normal part of the gait cycle, happening from the time your heel hits the ground to mid-stance. The following video provides more information. Be warned: the video is quite technical. However, if you only listen to the first few seconds, you will hear the explanation of why pronation is needed for healthy walking biomechanics, which is the point I want you to remember.


Unfortunately, for many of us, pronation has become a dirty word and is something we try to avoid. During my physical therapy treatments, I was told I overpronate. Let’s not forget that qualifier “over.” Regardless, I didn’t appreciate the difference between pronation and overpronation, so I purposely tried to walk without letting my feet collapse inward. Talking with clients, I realized that I was not the only one who had adopted this faulty technique to control overpronation.


While attending the Postural Restoration Institute (PRI)® course, Impingement & Instability, last winter, the instructor and clinic director, Ron Hruska, MPA, PT, described the importance of feeling your big toe when you walk. Big toe awareness is an indicator or proper foot pronation during gait. I checked it out on myself and found that I had no connection with my big toe as I strode around the room. I talked with Ron about it, and we discussed how so many people, like me, become afraid of pronating their feet. We have all associated pronation with something very bad, so we consciously avoid this movement. Instead, we force ourselves into a position of supination, as shown in the middle picture on the image above. When you supinate, your foot actually rolls outward.


From an impingement and instability perspective, this is a problem. Your body needs stability. That starts at the ground. Stability is gained when structures of your body contact or impinge on one another. Pronation–rolling the foot inward–is needed for correct impingement of the ankle bones. In the class, I learned that these bones need to stack appropriately on top of each other to support your structure and for proper foot biomechanics. If you tend to walk on the outside edge of your foot (supinate), your foot bones don’t touch on the inside, which creates instability in your foot and throughout your body.


Can you feel your big toes as you walk?

As you can see in the middle image above showing supination, you will not feel your big toe upon push-off when your foot is in this position. Rather, the pressure is directed to the outside area of the foot, as depicted by the red contact patch in the image. In neutral foot alignment, the image shows how the weight is distributed over the big toe as you take a step. This is also true for overpronation, though the red contact patch is positioned more inward than forward (as shown in neutral foot alignment) and is also accompanied by rotation of the rear foot inward (as noted by the arrow).


It is always a good idea to have your gait analyzed by a professional and obtain foot orthotics, if needed. I use orthotics to correct my foot overprontation. For more information on shoe inserts, check out my blog: Foot Orthotics and Joint Pain. Any foot orthotic should allow normal pronation. One of my client’s orthotics was so over built she couldn’t pronate and was stuck in supination, which prolonged her pain and disability.


Embrace foot pronation and ankle impingement for a pain-free active lifestyle supported by stable, well-aligned, and functional feet!

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