Pronation during running is normal. Excessive pronation, however, causes all sorts of trouble. Beginning runners and those moving into longer or more intense running regimens may notice extra fatigue or persistent aches and pains in feet, legs or lower back. Pain during and immediately after running that fades in a few hours may be caused by the way your legs and feet twist and rotate when you run. Shoes that seem to fall into or away from each other can point toward a solution.
Definition
In a normal step, the outside of the heel hits the ground first. As the body moves forward, the foot adjusts to support your weight by rolling inward a bit, bringing all available foot surface into contact with the ground. This is pronation. This dynamic distribution of weight absorbs much of the bone-jarring shock in a running step. The body continues in motion, moving weight to the front of the foot, and you push off for another step.
Problems
If the foot rolls too far inward, signaling some structural stability anomaly, your body receives more impact. This is overpronation. The next step receives push from only the big and second toes. If the foot fails to roll inward properly, your body also absorbs more shock. This is underpronation, or supination. You push off from the small, outside toes. Either condition can result in pain.
Diagnosis
Set your used running shoes next to each other on an even surface at eye level. If they tilt toward each other, or inward, you overpronate. If they lean outward, you underpronate. If they stand straight up, you are a neutral pronator.
Causes
Overpronation is more common in runners whose feet have low arches. High-arched running feet more often are prey to supination or underpronation. Heredity and one's position while still in the womb determine most pronation abnormalities. Loose and weak soft tissue complexes can allow pronation difficulties to develop and often can be treated with exercise. Sometimes, pronation results from abnormalities higher in the body, such as weak hips. If simple fixes do not suffice, see a specialist, who will look beyond foot and ankle mechanics to pinpoint your difficulty.
Effects
At first, a runner who overpronates or supinates may simply feel more tired, especially in feet and lower legs, than does a neutral pronating runner. This is easy to overlook, because it's impossible to know the fatigue level of another person's limbs. The body itself may try to compensate by pointing toes a little upward or to the side, causing unusual stress in other ways. Eventually, an abnormal pronator may notice pain in the foot, lower legs, knees, hips or lower back. She may develop bunions, corns, heel spurs, shin splints, ankle sprains, plantar fasciitis or hamstring troubles.
Treatment
It often is enough to buy stability or motion-control running shoes. Those with high or low arches may add a corrective orthotic to all footwear. If difficulties do not resolve, however, seek help from an orthopedic physician, a physical therapist trained in sports medicine or a podiatrist. Some specialty sports and running stores offer gait analysis and match shoes to your pattern of running.
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