Supination

What is Supination?

As part of a normal stride, your rear-foot should roll inward a bit after your heel hits the ground, cushioning the impact and helping you adapt to uneven surfaces. This is called pronation. 

But if your rear-foot doesn't roll in far enough, or seems to roll outward? That's supination. When supination occurs, your foot no longer properly absorbs the shock of each step. Instead, the outside of your foot bears the full force of your step's impact. 

Supination, or under-pronation, is common among people with high arches or tight Achilles tendons (the stretchy bands of tissue that connect your calf muscles to your heels).  

Supination is considered natural for some people, but it places extra stress on your foot and leg that can cause problems elsewhere. 

Under-pronating can cause: 

• Pain in your joints 
• Ankle injuries or sprains
• Achilles tendonitis 
• Plantar fasciitis 
• Knee pain and swelling 
• Inflammation or tightness in the outer thigh and knee (also known as “iliotibial band syndrome”) 
• Hammertoes 

Think You Might Supinate? 

Take a closer look at where you feel pain. 

What areas of my body hurt? 

•  Outer thigh 
• Knees 
•  Ankle 
•  Outside of foot 
•  Achilles tendon 
•  Heel 
• Toes 

Take the below self-assessment quiz:

Do I suffer frequent: 

• Ankle sprains or pain? 
• Pain or swelling in my knee? 
• Muscle tightness or inflammation in the outer thigh or knee? 

If you answered yes to any of these questions, you show symptoms that may be caused by supination. TAKE THE NEXT QUIZ TO FIND OUT IF YOU ARE AT HIGH RISK FOR SUPINATION. 

Do I have: 

• High arches? 
• Tight Achilles tendons? 
• Toes that turn inward (pigeon toes)? 

If you answered yes to any of these questions,  it's possible your symptoms stem from supination. 

Next, find a well-worn pair of your running or walking shoes. 

Do they: 

• Show uneven, heavier wear on the outside edge of the sole? 
• Tilt outward when placed on a flat surface? 

If you answered yes to either of these questions, you likely supinate. Make an appointment with a podiatrist to confirm your condition. 

Are there any serious concerns with supination? 

Repetitive injuries are the biggest concerns with supination. If you supinate, you may end up with recurrent Achilles tendonitis, swollen painful knees, or outer thigh pain. If left unchecked, those injuries will worsen over time and may lead to stress fractures. 

People who supinate also have a tendency to roll and sprain their ankles because they place so much weight and pressure on the outside and rear of the foot. It can be a vicious cycle, since sprains weaken the ankle, which leads to more sprains! A moderate to serious sprain could keep you off your feet for weeks. 

Treatment and Prevention 

If you’ve detected supination, what should you do? Supination may just be part of your natural gait. But you can correct it—and avoid the many associated effects—with some simple measures. 

Wear shoes with: 

• Extra cushioning to help absorb the force of impact. 
• A straighter instep shape—called a last—to control inward motion and counter supination. 
• Flexibility and lightweight materials, to allow for more foot motion. 

Also consider the following remedies to help correct your supination, stabilize your feet, and reduce pain. 

• Use deep heel cups. 
• Use  orthotics and insoles. 
• Replace worn shoes diligently. 
• Use lateral heel wedges—inserts that stabilize your heel to keep your foot from rolling in or out. 
• Do extra stretching of calves, hamstrings, quads, and outer thighs, including your iliotibial band, which runs from your hip to just under your knee and helps stabilize the knee while running. 

If you suffer frequent ankle sprains or pain, you should also: 

• Wear ankle supports. 
• Wear high-topped shoes that extend up over your ankle for athletic activities. The good news? There are lots of fashionable high-topped options available these days.  

This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider on all matters relating to this or any other condition that may affect your health.