Over-pronation & Under-pronation

Pathomechanics is a clinically-used term to describe abnormal movements that cause pain or dysfunction in an individual. Two conditions Canadian Certified Pedorthists commonly see in the feet are overpronation and under pronation (or supination).


Overpronation is a condition in which the foot rolls excessively down and inward. The arch may elongate and collapse (or ‘fall’) and the heel will lean inward. Overpronation should not be confused with pronation. Pronation is a normal motion of the foot during weight bearing, allowing the foot to absorb shock as it contacts the ground. Common conditions seen with overpronation:
  • Heel pain or plantar fasciitis
  • Achilles tendinopathy
  • Hallus valgus and/or bunions
  • Patellofemoral pain syndrome
  • Iliotibial band pain syndrome
  • Low back pain
  • Shin splints
  • Stress fractures in the foot or lower leg

Under pronation

Under pronation is a condition commonly referred to as supination. An under pronated foot structure may have an abnormally high arch or instep that has very little flexibility when standing. The heel often leans outward, putting more weight on the outer edge of the foot. Callousing is common under the knuckle of the baby toe because of the weight on the outside of the foot. Common conditions seen with under pronation:
  • Heel pain or plantar fasciitis
  • Achilles tendinopathy
  • Metatarsalgia
  • Iliotibial band syndrome
  • Lateral ankle sprains
  • Stress fractures in the foot and lower leg
  • Medial tibial stress syndrome

Pedorthic Pointers for Patients

Overpronation and underpronation describe general foot movements. These terms do not necessarily describe a medical problem. For example, you can overpronate and not have any problems or symptoms at all. It is important to have your foot structure and symptoms adequately assessed by your prescribing physician and a qualified practitioner such as a Canadian Certified Pedorthist. Once the underlying conditions and mechanical faults are assessed, an appropriate treatment plan including possible orthotic and footwear recommendations can be made. Adequate footwear can often help with conditions related to flat feet and high arches. Canadian Certified Pedorthists recommend selecting shoes featuring:
  • Heel counters that make the heel of the shoe stronger to help resist/reduce excessive rearfoot motions. The heel counter is the hard piece in the back of the shoe that controls the foot’s motion from side-to-side. You can quickly test the effectiveness of a shoe’s heel counter by placing the shoe in the palm of your hand and putting your thumb in the mid-portion of the heel and trying to bend the back of the shoe. A heel counter that does not bend very much will provide superior motion control.
  • Appropriate midsole density – the firmer the density, the more it will resist motion (important for a foot that overpronates or is pes planus), and the softer the density, the more it will shock absorb (important for a cavus foot with poor shock absorption).
  • Wide base of support through the midfoot, to provide more support under a foot that is overpronated or the middle of the foot is collapsed inward.
If you are experiencing foot pain or discomfort, consult a Canadian Certified Pedorthist for pedorthic management services including orthopaedic footwear, shoe selection guidance and orthotics.