“Overpronation” is a regularly used and misused term by runners and health professionals in the framework of oversue injuries and the prescribing of running shoes. Pronation is a normal movement of the foot where the ankle tilts medially and the mid-foot of the foot drop. This is what the foot is designed to do because it is how the feet adapts to unequal surfaces and absorbs shock. It is very normal and nothing wrong with it. The way in which some runners chat about what they have learn about it, you would believe they have some kind of disease.
Where the problem occurs is that it is commonly considered a risk factor for having an overuse injury when running. For that reason, there are design features in running shoes which are believed to help runners with this alleged too much pronation. They are what are known as the motion running footwear. In comparison, the neutral running footwear do not have these types of design features directed at getting rid of the so-called too much pronation.
The challenge with the thought of Overpronation is that there isn't a agreement on what is ‘normal’ what is actually 'too much'. Many runners with severe overpronation get no problems and other runners with only small amounts get lots of complaints. The actual proof linking overpronation to a running injury is also very weak. The general opinion of the systematic evaluations of the data is that it is only a small risk factor, making it not really a major problem due to so many additional factors which go into runners getting an overuse injury.
Therefore should it be treated? Yes, if it is causing the issue. No, if it is not bringing about the issue. This is often tricky to decide. A key in deciding if it is contributing to the issue is to decide if the forces in the foot that it is causing are sufficient to damage the foot. The supination resistance test may help here in helping decide this. If that test is higher, then the loads are high, so the overpronation should probably be treated. If the loads are lower, then it might not be important to manage it.
If it has to be treated, then the cause of the problem needs to be addressed. There is not a one-size-fits-all in relation to too much pronation. If a muscle weakness is the cause of the problem, then strengthening such as the short foot exercise can help (it won’t help other causes). When tight calf muscles are the problem, then stretching is important (muscles strengthening or foot orthotics will not work in these); if a bony positioning, for example forefoot varus, problem is the cause, then only foot orthoses are going to help (strengthening muscles and calf muscle stretching will fail); and so it goes on. The cause must be resolved.
There are plenty of fallacies and half truths being perpetuated about overpronation. An important warning sign is that whoever is speaking or blogging about too much pronation is, if they advocate a one-site-fits-all with regards to this, then they probably don't know what they're writing about.
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