Overpronation: Causes, treatment, and exercises

Overpronation is when the arch of the foot collapses excessively downward or inward. A doctor may call this ‘pes planus’ or ‘flexible flatfoot’. It is commonly known as flat feet.

The way a person’s foot strikes the ground can affect the rest of their body. People who overpronate may have a higher risk of certain injuries than people with normal pronation.

Flat feet are common in children but usually resolve in time without intervention. The arch of the foot does not usually develop until around the age of 5 years, but it may take longer.

Various lifestyle and treatment strategies can help manage overpronation.

Pronation and overpronation

Overpronation and flat feet or fallen arches. Image credit: FA RenLis, (2011, January 26)

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Overpronation is when the arches of the foot roll inward or downward when walking, and is often referred to as flat feet.
Image credit: FA RenLis, (2011, January 26)

Pronation refers to how the foot moves from side to side when a person walks or runs. It occurs as the weight transfers from the heel to the ball of the foot as a person goes through their walking or running stride.

Pronation also occurs while standing, and in this case, pronation refers to the amount that the foot rolls inward toward the arch.

Overpronation is when the foot rolls too far inward toward the arch. Underpronation, or supination, in contrast, is when the feet roll outward.

Causes

Overpronation can happen if the arch is very flexible.

Overpronation, causing fallen arch and flat foot, demonstrated in diagram alongside hollow foot or high arch, known as supination.

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Overpronation may be caused by a fallen arch, commonly known as flat foot.

Sometimes, people are born with flat feet. However, some conditions and activities can increase the risk of developing flat feet or weakened arches, which can lead to overpronation.

Adult acquired flat foot can occur if a person:

  • has inflammation or damage to the tendon
  • has obesity
  • plays a high impact sport, such as basketball
  • has arthritis that affects the cartilage and ligaments in the foot
  • has an injury that affects the alignment of the joints in a foot
  • has a nerve problem that prevents them from feeling when the arch is collapsing, for example, due to diabetes

Overpronation can also occur during pregnancy but usually resolves after delivery.

Treatment options

Most people do not need treatment for flat feet, but the following options may help manage pain and reduce the chance of an injury:

  • choosing supportive or motion control shoes, also known as overpronation shoes
  • using orthotics
  • managing pain with nonsteroidal anti-inflammatory drugs (NSAIDs)
  • managing weight through diet and exercise, if appropriate
  • surgery, in some cases
  • doing exercises that strengthen the arches and muscles around them

Footwear

A person with overpronation should choose supportive shoes, especially for activities that involve repeated foot strikes, such as running or walking.

The person should choose shoes that offer extra support and stability to minimize the impact of each step.

Features of supportive shoes for people with overpronation include:

  • checking that the shoe has a strong and inflexible heel counter, the hard piece in the back that stops the foot moving from side to side
  • choosing shoes with a dense midsole, as it will uphold the arch
  • opting for a wide base of support for the middle of the foot to prevent the arch collapsing inward

Other tips when buying shoes include:

  • asking the sales associate to measure both feet
  • shopping for shoes at the end of the day when feet are more likely to be a little puffy
  • wearing thin socks when shopping for shoes, as thick socks can lead to choosing shoes that are too tight
  • choosing a specialty walking or running store, which is more likely to have equipment for assessing gait

Some running stores have equipment that highlights which part of the foot touches the ground when a person walks. This can help show if a person needs shoes with a specific type of support.

A person can also look at the soles of their shoes to see where most wear has taken place. Wearing on the inside edge can be a sign of overpronation.

A podiatrist or orthopedic surgeon can also recommend suitable shoes, such as anti-pronation shoes, which experts suggest may help reduce physical fatigue due to overpronation.

Exercises for overpronation

Sometimes, a physical therapist will recommend strengthening exercises for people with overpronation. These exercises can help support the arches of their feet and the muscles that help support the arches.

Here are some exercises that may help:

Heel stretches

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  1. Stand with both feet flat on the floor.
  2. Step forward with one foot, so it is around one pace in front of the other.
  3. Keep the spine straight, bend the front leg and push forward so that all your weight is on the front foot.
  4. Feel the stretch in the back leg and Achilles tendon.
  5. Hold for 30 seconds.
  6. Change feet and repeat four times.

Tennis ball rolls

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Active Body. Creative Mind.

  1. Sit with both feet flat on the floor.
  2. Place a tennis ball or golf ball under one foot.
  3. Keeping the spine straight, roll the ball back and forth under the foot for 2–3 minutes.
  4. Switch and repeat with the other foot.

Calf raises

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  1. Stand with both feet on the ground
  2. Lift both heels as high as possible, hold for 5 seconds, then lower them.
  3. Repeat 15–20 times.
  4. Alternatively, use a stair or exercise step and allow the heels to rise and below the step level.

Toe raises

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  1. Stand with both feet on the floor.
  2. Press the right big toe into the floor and lift the other toes of the right foot.
  3. Hold for 5 seconds.
  4. Next, press the four smaller toes into the floor and raise the big toe for 5 seconds.
  5. Repeat each exercise 5–10 times.
  6. Change and repeat with the other foot.

In a 2015 study, 58 young athletes between 9–12 years participated in an exercise program. In 10 of the participants, overpronation affected their gait. After 6 months, all the participants had a typical gait, suggesting that specific exercises may improve gait and reduce overpronation in children.

Wearing orthotics

Orthotics are special inserts that slip into shoes to offer extra arch support and help minimize the impact of the way someone walks.

Generic orthotics are available without a prescription and may provide enough support to prevent injuries due to overpronation.

In some cases, though, a person with overpronation may require custom orthotics, which a podiatrist can order based on an analysis of the person’s walking style.

A 2015 study looked at 20 children with flexible flat feet who wore custom-made orthoses for 3 months. At the end of the study, tests showed they had less pain and improved balance.

Most people do not need treatment for flat feet, but a specialist can offer advice on orthotics and other strategies for maintaining foot health.

A person should seek medical advice if they:

  • have ongoing pain, weakness, numbness, or stiffness in their feet
  • often have injuries to the feet or ankles
  • have difficulty with walking or balance
  • did not previously have flat feet
  • have one flat foot only

If a child has persistent pain or has not developed an arch by their teens, they may need to consult a doctor. The doctor may check for an underlying problem, such as tightness in the Achilles tendon, or assess for a more serious condition, such as rigid flatfoot.

Diagnosis

Many people who overpronate know they have flat feet without consulting a doctor.

If a person thinks they may overpronate, then they can self assess first using one of the three following methods:

  1. First, look at the feet while standing. If there is no clear space between the foot and the floor where the arch should be, the person likely overpronates.
  2. Second, check the soles of a pair of shoes. If most of the wear is on the inner edge, there may be overpronation.
  3. Third, check a footprint after taking a few steps with bare, wet feet. A person with normal pronation will notice their heelprint connected to the toeprints with about half of their foot width. A person who overpronates will notice their heelprint connected with the full width of their foot.

A person can also check with a specialty running store, a podiatrist, or an orthopedic surgeon. At some specialty running stores, the sales associates are trained to check for overpronation.

A podiatrist, orthopedic surgeon, or physical therapist can make a definite diagnosis. A person should consult a specialist for overpronation if they are experiencing pain or chronic injury, especially if they have tried to self-correct the problem in the past.

If a doctor suspects an underlying problem, such as a ligament injury or sensory neuropathy, they may recommend tests such as an MRI, a nerve conduction study, or a radiograph.

Other conditions that can resemble overpronation include:

  • having a prominent fat pad, which can occur in children
  • fluid retention, which can cause the bottom of the foot to touch the floor
  • a benign or malignant growth or tumor affecting a structure under the foot

Prevention

It is not always possible to prevent overpronation, but people can reduce its impact by using orthotics and supportive footwear.

Following a recommended exercise plan may strengthen the foot and lower the risk of injury.

Maintaining a healthy weight can also help reduce the risk.

Summary

Overpronation — sometimes called flat feet — is when a person’s foot leans too much toward the center when walking, running, or standing. Many people are born with flat feet, but it can also develop over time due to obesity, tendon damage, and other conditions.

A doctor can advise on suitable footwear and orthotics to help support the feet. If necessary, they may recommend options to help relieve pain and prevent injury.

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