Do you supinate? Can shoes correct overpronation? How is pronation related to injuries? We’ve spent over 40 hours researching pronation and presented it all in this guide.
If your runs are comfortable with no issues, don’t bother with pronation. However, if you’re experiencing discomfort, it’s always best to consult a specialist (e.g. podiatrist).
Disclaimer: The purpose of this guide is to educate, not to make any medical diagnosis or recommendation.
What is pronation?
When running, the foot hits the ground, the arch collapses to absorb the shock, and the rearfoot rolls inward at the ankle. This motion is called pronation. It’s normal for a joint to pronate and it’s a necessary component of the gait cycle.
Based on the angle of pronation, there are 3 types of this motion:
- Overpronation - when the ankle rolls far too inward. This is the most common case. Runners who overpronate place more weight on the medial side of the foot.
- Neutral or “normal” pronation.
- Underpronation (also called supination) - when the ankle rolls outward. Only a small percentage of runners underpronate (or supinate). Those who do place more weight on the lateral side of the foot.
There isn’t a consensus regarding the angle that separates types of pronation. We found 15° to be mentioned, but it’s not a widely accepted criteria.
Why pronation matters?
Because when a runner overpronates or supinates, it’s more difficult for their foot to handle the shock and their stride is less efficient than of runners who pronate neutrally. This messes up with the running form and might lead to injuries - whatever the cause is.
That’s why scientists and running enthusiasts pay so much attention to pronation and work on improvements by exercising and/or finding specific shoes.
In our lab, we cut all shoes in half. When dig deep into all the details and cutting shoes in half allows us to analyse all the stability (overpronation) elements present in the shoe.
Do you overpronate, supinate or pronate neutrally?
There are numerous methods used for pronation determination. But, not all are good enough.
Some methods cover only arch height (footprint analysis) and relate that to pronation. Pronation has more components to it and they are often neglected. The main issue here is that someone can be overpronated based on one parameter and not overpronated based on another parameter. Also, the best assessments are done when a person is moving (running on a treadmill, for example), since pronation is about motion not standing still.
The best way to determine pronation (in order of quality):
- Visit a specialist (e.g. biomechanics specialist or podiatrist) who has the equipment and knowledge to do it.
- Go to a running store that has the equipment for this, usually a treadmill with sensors and cameras.
- Self-assessment methods are of the lowest quality. As shown in this study, runners correctly determine their foot type in less than 50% of cases.
Some of the methods used for pronation and arch height measurements are: footprint analysis (the wet test), medial longitudinal arch angle, navicular drop test, rearfoot angle, subtalar joint neutral, forefoot angle, arch height index, foot pronation index.
Here, we will focus on the footprint analysis and foot pronation index. The first one is the most popular self-assessment method among runners. The second one is the only one to offer an insight into what pronation determination should cover without fancy equipment. In scientific studies, the foot pronation index is becoming a norm.
Test: DIY footprint analysis (the wet test)
Here runners rely on the wet test and these criteria:
| Arch Height | Pronation |
| Low or flat | Overpronation (Look for overpronation running shoes) |
| Normal | Neutral (Look for neutral running shoes) |
| High | Underpronation (Look for neutral running shoes) |
- Pros: easy, fast, DIY, no fancy equipment needed.
- Cons: not reliable for pronation. One can have a high arch but also an everted heel bone. Or one can have a low-arched foot with a vertical heel bone. This means it’s important to determine the height of the arch but keep it as only one part of the puzzle.
The process looks like this:
- Perform a wet test
- Look at the results and
- Compare the results to the ones in the table.
Keep in mind that the wet test is just an approximation.
Foot posture index
Foot Posture Index (FPI) quantifies the degree to which a foot is pronated, neutral or supinated.
It is usually practised by specialists, but we describe it in detail, mainly so the complexity of the process can sink in. This way, the other methods should become of less value as standalone pronation tests.
- Pros: captures information in multiple foot segments without complex measurement techniques or equipment, more valid than other static methods.
- Cons: it’s still a measure of standing foot posture, so it’s not a replacement for gait assessment, plus you can’t do it yourself.
Series of six observations and palpation are made and scored from -2 to 2. 0 is considered a neutral foot, a positive score is given for a pronated and negative for a supinated foot.
Here we’ll describe all 6 steps in FPI using the defined values.
Step 1: Talar head palpation.
| Talar head palpation: possible scores | |
| Score | Criteria |
| -2 | Palpable on the lateral side (it is protruding there) and not at all on the medial side. |
| -1 | Palpable on the lateral side and slightly on the medial side. |
| 0 | Equally palpable on both sides. |
| 1 | Palpable on the lateral side and slightly on the medial side. |
| 2 | Palpable on the medial side and not at all on the lateral side. |
Step 2: Curves above and below the lateral malleolus.
| Lateral malleolus curvature (viewed from behind) | |
| Score | Criteria |
| -2 | The curve below the malleolus is either straight or convex. |
| -1 | The curve below the malleolus is more convex or more flat than the one above the malleolus. |
| 0 | No difference between the curves above and below the malleolus. |
| 1 | The curve below the malleolus is more concave than the one above the malleolus. |
| 2 | The curve below the malleolus is significantly more concave than the one above the malleolus. |
Step 3: Calcaneal inversion and eversion, the frontal plane.
| Calcaneal frontal plane position (viewed from behind) | |
| Score | Criteria |
| -2 | Inverted more than 5 degrees (varus) |
| -1 | Between vertical and an estimated 5 degrees inverted (varus) |
| 0 | Vertical |
| 1 | Between vertical and an estimated 5 degrees everted (valgus) |
| 2 | Everted more than 5 degrees (valgus) |
Step 4: Foot in the transverse plane with a focus on the taillow navicular congruence.
| Taillow navicular prominence | |
| Score | Criteria |
| -2 | Markedly concave. |
| -1 | Slightly concave. |
| 0 | Flat |
| 1 | Slightly bulging. |
| 2 | Markedly bulging. |
Step 5: Sagittal plane with the focus on medial arch height.
| Congruence of medial longitudinal arch viewed from inside. | |
| Score | Criteria |
| -2 | High arch and acutely angled toward the posterior end of the medial arch. |
| -1 | Moderately high arch and slightly acute posteriorly. |
| 0 | Normal height and concentrically curved. |
| 1 | Lowered arch with some flattening in the central position. |
| 2 | Arch very low with severe flattening in the central portion (arch making ground contact). |
Step 6: Transverse plane with the focus on forefoot adduction and abduction.
| Abduction/adduction of the forefoot (viewed from behind) | |
| Score | Criteria |
| -2 | No lateral toes visible. Medial toes clearly visible. |
| -1 | Medial toes more visible than lateral. |
| 0 | Medial and lateral toes equally visible. |
| 1 | Lateral toes more visible than medial. |
| 2 | No medial toes visible. Lateral toes clearly visible. |
Now all these scores are filled in the FPI sheet and added.
It’s obvious that a possible score falls in the range between -12 to 12. This is where it gets tricky: Scientists and specialists didn’t find a consensus on the results. The lack of strong consensus led to different studies choosing different score ranges for each category. These are some of the possible results:
- Normal foot: 0 up to +5
- Pronated foot: +6 to +9
- Highly pronated foot: 10 and up
- Supinated foot: -1 to -4
- Highly supinated: -5 to -12
Another study went by these numbers:
- Neutral 0-7
- Pronated 7-10
- Highly pronated higher than 10
The issue with this approach is that anything above 0 is pronated. Generally, 0-4 is considered to be a normal range and anything above 4 overpronated. The normal adult population has an FPI Score of +4 which confirms that a slightly pronated foot posture is the normal position at rest (as described in detail here).
Shoes you need based on your pronation or arch height
If you’re enjoying your pair of running shoes and experiencing no problems, don’t overthink pronation and enjoy your run.
If you don’t visit someone knowledgeable and owning the equipment needed to determine pronation, you will probably base your decision on shoe wear or footprint analysis (the wet test).
This means you’ll use the logic shown in the table below to choose your running shoes. You might notice that supinators are left out - shoe brands aren’t making shoes for them. They run in neutral shoes.
Even if you had your pronation determined by a doctor, if you’re overpronating you’ll go for stability running shoes or motion control shoes, and if you’re pronating neutrally or if you’re an underpronator, you’ll look for neutral running shoes.
Features of neutral, stability and motion control running shoes
This is an overview of the most important shoe features and how they differentiate between neutral, stability and motion control running shoes. Motion-control shoes are very rare today and runners with severe overpronation would usually go for custom-made orthotics and stability shoes.
It's also important to note that runners who need stability need it way more in daily trainers. That's because more support and stability is needed at slower paces. When we start running faster, ground contact times are shorter, so we need less support and stability. That's why speed and race shoes rarely have stability elements.
1) very soft sock-like back with no heel counter vs very padded and stiff heel counter
2) no side walls vs present side walls (GuideRails)
3) no heel flare vs very prominent heel flare
4) outsole design with less ground contact vs a lot of ground contact
Stability running shoes vs. stable running shoes
Stability running shoes have certain technologies or design elements that make them very stable for those who overpronate.
Stability running shoes are not neutral shoes that are stable.
Stable neutral running shoes are still neutral shoes, which means they are not recommended for runners who experience moderate to severe overpronation.
|
Stability shoes |
Stable neutral shoes |
|
Both can have geometry elements that provide stability, like a wider base, heel flare, side walls… |
|
|
Only stability shoes have GuideRails, GuideRail, J frame, H frame, etc. |
|
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Both can work for mild pronation. |
|
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Best for moderate overpronation. |
Best for neutral pronation. |
|
Usually stiffer than neutral running shoes |
Usually more flexible and softer than stability shoes |
How to recognise stability/overpronation running shoes
Stability running shoes are equipped with
- characteristic geometry elements that make them more supportive and stable, and/or
- trademarked technologies developed by shoe brands.
We will explain all of those below.
2. dual-density midsole (softer foam closer to the foot, firmer at the bottom)
3. heel bevel 4. side walls 5. stiff and wide base
6. forefoot sole flare 7. heel sole flare
Geometry elements used in stability running shoes
This is where shoe design comes into play. There are different elements used in stability running shoes and, usually, it’s more than 1 present. They are also often combined with trademarked technologies. Elements that we usually see: dual-density midsoles, heel bevel, sole flare, side walls, medial post, stiff and padded heel counters, stiff and wide base, stiffer upper overlays, straighter last profile, full-ground contact outsole.
Some trademarked technologies incorporate a combination of geometry elements. For example, Saucony’s Guide 17 combines a broad platform, higher sidewalls and an asymmetric profile.
Dual-density midsole in overpronation running shoes
As the name implies, the base is made of 2 midsoles that have different densities. The firmer (denser) one can be present under the arch, it can be present as Hoka’s J frame or H frame, or it can be any other variation that the brands come up with that helps with stability.
Role of medial post
Medial post is a piece of plastic or dense foam that is usually placed under the arch and it connects the arch and the heel. It’s rather stiff or hard and it prevents the arch from collapsing and the ankle from rolling inward (to a certain degree, of course).
This technology is now used less and less. We’ve seen it in old Brooks stability shoe models and, out of the newer ones, it’s worth mentioning that the New Balance Fresh Foam 860 v12 and v13 feature a medial post, just like Asics Gel Kayano 30.
Stiff and padded heel counters lock the foot in
For a heel to be stabilised and for a proper lockdown to be achieved in stability shoes, stiff heel counters are used. It's easy to notice them in our lab because we cut all the shoes in half.
The counter can be embedded into the padding (internal heel counter) or it can be a piece of plastic or similar material that’s glued on the outside of the shoe.
However it is achieved, it should be stiff.
Assessing the stiffness of a heel counter in RunRepeat lab
In our lab, we assess the stiffness of the heel counter by pushing it and squeezing it. We rate it on a 1-5 scale, where 5 is the stiffest.
These heel counters are not just stiff but also padded. They cradle the heel nicely to make it super locked in and stable.
| If this topic is of interest to you, we’ve put together an in-depth guide on heel counters: The role of heel counters in running shoes. |
Stiff base improves stability
Stiffer midsoles are more stable. When overpronating, whether to a mild, moderate, or severe extent, additional wobbling is not a welcome movement. Some overpronation shoes feature plates or rods to make them stiff. Others simply have stiffer construction (thicker outsoles, dense foams, etc).
Here, we differentiate longitudinal stiffness and torsional rigidity. In our lab, we test for longitudinal stiffness by bending the shoe to 90 degrees using or digital force gauge. The more force we need, the stiffer the shoe.
Testing longitudinal stiffness of running shoes in RunRepeat lab
We don’t stop there, we also twist the shoes using our hands and assess torsional rigidity on a 1-5 scale, where 5 is the most rigid.
Testing torsional rigidity of running shoes
Usually, stability shoes are firmer and/or stiffer, but with the rising popularity of carbon plates used not only in race shoes but also in some tempo shoes and daily trainers, neutral shoes are becoming stiffer.
The wider the base, the more stable the shoe
A wide base helps give a more planted feel when landing on the ground. Less wobbling is always welcome. Overpronation running shoes tend to have a wide base unlike some neutral shoes, especially race ones.
In our shoe lab, we measure the width of the base in 2 places: at the heel and at the forefoot. Of course, we prioritise the heel width in stability running shoes because runners who need stability land on the heel.
Full-ground contact outsole is best for overpronation
Of course, more ground contact means more stability. Some shoes (neutral and competition shoes, especially!) have chunks of outsoles and midsoles removed to save weight or create a more flexible base. In stability shoes, ground contact is prioritised.
Stability shoes tend to have straighter (flatter) lasts, while race shoes have very curved lasts.
Side walls
Sidewalls are midsole extensions on the sides of shoes, usually around the arch and/or heel, that create “walls” that stabilise the foot.
Side walls can create an illusion that the heel drop is lower than it actually is because we can’t clearly see the heel drop. But, don’t worry, we cut all the shoes in half anyway and measure the stack heights according to the WorldAthletics guidelines, so our heel drop measurements are accurate regardless of the sidewalls!
Heel bevel is a must for overpronators
The heel bevel is a curved heel. It’s there to imitate the shape of our heel bone. The bone is curved, and so should the back of the shoe be because such geometry makes the landing easier. The heel bevel improves the transition for heel strikers and reduces the stress in the tibialis anterior muscle.
When we say that a heel bevel is a must, we mean that it's VERY useful in running shoes that are not minimalist. And overpronators rarely run in minimalist running shoes. The heel bevel is there to imitate the shape of our heel bone, and that curve decreases the demand on the ankle extensor muscles when the foot hits the ground. It basically eases the foot onto the ground because it lands on something curved and not straight.
Sole flare: where do you need it?
Sole flare is a protrusion of the midsole and we see it on both medial and lateral sides of the shoe. Sole flare is actually a part of the midsole that is wider than the upper.
Runners who land on the outer side of the forefoot should be cautious when it comes to having a lateral forefoot flare. It might cause your foot to hit the ground before it's ready because there's a lot more material there. However, medial forefoot flare is great for those who pronate at the forefoot.
Heel strikers benefit from the heel sole flare, especially the lateral one as they usually land on the outer side of the heel and need stabilisation in that area. If runners land on the medial side of the heel, then the flare placed on the inner side provides resistance to the inward roll of the foot.
Runners who land on the outer side of the heel and then pronate naturally should be cautious when it comes to the lateral heel flare as it might initiate and early ground contact when their feet are not ready to hit the ground.
More structure in the upper
These overlays might be the least effective or, to put it better, shoes with stiff overlays are not stability shoes. But, in stability shoes, having structural overlays can help with stability because these overlays give more structure to the upper.
This means that the feet are locked in better and might experience less lateral movement.
Brand’s trademarked technologies for stability shoes
Here, we list different technologies that brands have developed to make stability shoes. These technologies are combined with different geometry elements (mentioned in the section above). We're not listing all the technologies present on the market but more popular ones.
GuideRails by Brooks
Avoiding the use of traditional posts, GuideRails are made of 2 pieces of firmer foam on either side of the heel. The inside piece reduces the rolling of the foot inward, and the outside piece is firmer and higher and it stabilises the heel by reducing its outward motion.
All the shoes from Brooks that utilise the GuideRails are stability shoes, they have “GTS” (for go-to stability) in their name, and they are easy to recognise as the newer models have the GuideRails design in stripes.
GuideRail by Altra
Higher and firmer foam that offers medial support (on the inner side of the shoe).
J-Frame by Hoka
J-shaped supportive structure (denser foam) with extended heel support. It goes around the heel, forming the J shape. In many colorways, this denser foam is of different colour, so it’s easy to notice. In the image below, it is grey, while the rest of the midsole is white.
H-Frame by Hoka
H-Frame is a support structure that is more shaped like a number 8 than a letter H. And the cutouts allow the foot to be in direct contact with the plush foam which results in a stable, soft shoe.
4D guidance system by Asics
4D means there are 4 stability elements.
1. increased heel bevel, 2. sculpted midsole, 3. wider base, 4. medial post
3D guidance system by Asics
3D means there are 3 stability elements.
1. increased heel bevel, 2. wider base, 3. forefoot flare
Mizuno’s Wave plate
This plate helps stop the arch from collapsing and offers stability. It’s easy to notice on the shoe as it’s of a different colour than the midsole.
A variation of the Wave plate where the rubber wall is integrated into it is present in a stability shoe Mizuno Wave Horizon 6:
Mizuno’s Double fan-shaped wave
Similar to the Mizuno Wave plate but here we have a one-wave structure on the lateral side that cushions the foot AND we have a double fan-shaped wave on the medial side that prevents the arch from collapsing. Present in Mizuno Equate shoes.
Can shoes help with overpronation?
Yes, but not a lot.
The scientific evidence is all over the place and this is why: they all put overpronating runners in the same group. As explained above, there are many causes of overpronation. That’s why shoes can’t help everyone. Ideally, a study should control for the cause of overpronation. But none does.
| The effects of shoes on pronation |
| Motion control shoes can reduce pronation by ~2% when compared with barefoot or simple cushioned shoes, as shown in this study. |
| Motion control shoes control rearfoot motion better than cushion shoes. This was found in a study where 20 high-arched and 20 low-arched recreational runners were recruited to wear motion control and cushioning shoes. |
| In a study where female runners overpronated more than 6 degrees, motion control shoes were found to reduce pronation by 3.3 degrees before the run, but after 1 mile they made no difference (compared to the cushioned shoes). |
| It was observed that anti-pronation shoes reduce peak rearfoot eversion by ~3 degrees in this study. |
| Runners who overpronate and use standard shoes have a higher injury risk compared to those with neutral feet >((hr)). |
What definitely does work is foot orthotics and if you’re looking into that solution, the best thing is to consult a specialist, not buy over-the-counter ones.
Pronation and injury
There is no definitive proof of excessive pronation directly causing injuries.
There are runners who overpronate only a bit and experience problems and there are runners who have a moderate case of overpronation and yet experience no issues.
Pronation becomes a cause of the injury when it contributes to increased load in the tissues and when this load is beyond what the tissues can take. Then, the forces associated with the load are high enough to cause damage.
There is a magnitude of forces related to pronation. That’s why there are many issues when trying to correlate (excessive) pronation to injuries directly. And that’s why scientific findings are all over the place as shown below:
| Question | Answer |
| Who’s at greater risk? |
This metastudy of 28 studies found that high-arched and low-arched feet have a slightly higher risk of injury than normally arched feet. A year-long study of 927 runners showed no correlation between arch height and injury rates. They all ran in neutral shoes, no matter their pronation. The US military did a 7,203-person study that reported no difference in injury rates between those who were assigned shoes based on the shape of their arch and those who got stability shoes regardless of their arch. When 372 recreational runners were given either the motion control or the standard running shoes and followed up for 6 months, it was found that the overall injury risk was lower in overpronating runners who had received motion control shoes compared to those who got standard shoes. |
| Where do injuries happen? |
A study has tested 40 runners and discovered that the location of the injuries varies with arch height. Another study of 1,597 showed that those with the lowest arches were more likely to have knee pain than those with the highest arches. |
Things you must know about pronation (and never be fooled again)
Given all the noise out there regarding pronation, we decided to create a summary of things we do (not) know:
- Pronation is not a disease. It’s a type of motion and it’s completely normal.
- You should look for treatment if you’re overpronating AND feeling discomfort. The best way to do this is to discover what’s causing excessive pronation first.
- There isn’t one cause of overpronation and supination and that’s why they can’t be “fixed” with one thing (e.g. shoes) only.
- There are no shoes for people who underpronate, they wear neutral running shoes (just like people with neutral pronation).
Also, in scientific terms, during overpronation, eversion, dorsiflexion (bending backward) and abduction (moving away from the midline of the body) happen at the same time.
Underpronation is just the opposite: it’s when inversion, adduction (moving toward the midline of the body) and plantarflexion (bending forward) happen simultaneously.
Why is pronation so confusing?
Pronation as a motion is straightforward.
However, there are many unknowns behind standardised data on pronation. They are the source of all the confusion. Here’s a list of them:
What causes overpronation
MANY things.
There are many forces involved in this motion and, therefore, many possible causes of excessive pronation: bony alignment issues (e.g. inverted position of the bones in the forefoot called forefoot varus), weak muscles (e.g. glutes, foot muscles, posterior tibial muscle), damaged arch, a tight calf muscle, etc.
The best thing would be not to experiment and see a specialist.
Recommended treatment for overpronation
Excessive overpronation is in most cases a sign of weakness and poor technique elsewhere in your running gait, not a disease to be treated.
If you watch elite runners and play the video in slow-mo or freeze-frame, you’d be surprised how many of them are overpronating and to what degree and yet they are pain-free. Keep in mind they devote themselves to running which means they work on their gait, form, everything.
To treat overpronation there should be an actual need for treatment and one needs to know the cause of it. This is the most difficult part which specialists should be consulted about.
If you google possible treatments without knowing the cause of your overpronation, you just might waste your time on strengthening the glutes when you should have got foot orthotics for a bony alignment issue.
Running-shoe market representation and prices
We’ve looked at all running shoes in the RunRepeat database and the percentage of running shoes grouped by stability features and different brands.
