Learning to focus on load, not just foot position
As a podiatrist, you work with patients on foot, ankle, knee, or running-related pain day in, and day out. How often have you had a patient walk in, looking for a second opinion, just to start off by telling you they have a history of overpronation? Someone watched them walk or run, noticed the foot rolling inward, and now that’s the cause for every bit of pain – and they can’t seem to find a good fix.
How often have you been the one to tell people they overpronate?
It’s commonly taught that overpronation is a pathology that needs fixing. Pronation, however, is a completely normal part of how the foot moves. It isn’t a flaw that needs correcting, and while overpronation can sometimes be part of the clinical picture, it’s never the whole story. In this article, we’ll start debunking misconceptions about overpronation.
Overpronation describes a foot that rolls inward more than expected while walking or running. On its own, that one word doesn’t convey clinical significance.
Every time a patient takes a step, the foot rolls inward slightly. That’s called foot pronation, and it’s the body’s natural way of absorbing shock and adapting to the ground underneath it.
Overpronation is not a distinct pathology. While excessive pronation can contribute to foot and lower limb issues, it is not as problematic as was previously thought. In patients where overpronation does exist, it is almost always not as important a consideration as other risk factors such as training load, recovery, and muscle strength (or lack thereof).
It’s easy to see the appeal of a simple answer for why a patient’s foot or knee hurts, but foot posture is just one data point among many, and it rarely holds up as a diagnosis on its own.
Pain and injury are almost always multifactorial. That means presentation could be influenced by how much the activity load has changed, how well tissues are tolerating that load, the patient’s strength and mobility, footwear choices, previous injury history, occupational demands, and the patient’s own goals. A single snapshot of how a foot rolls tells you very little about other contributing factors.
The causal link between overpronation and lower-limb pathology is weak. Plenty of people pronate and have no symptoms; plenty with relatively normal foot posture develop pathology. The foot position itself is not the root cause.
Rather, providers need to consider the way tissue is loaded, specifically if it’s loaded beyond its tolerance.
The treatment goals worth focusing on in any patient – with or without overpronation – are reducing their symptoms, improving their comfort level, supporting a return to the activities they care about, and managing load appropriately. This is exactly what MM Podiatry’s three-pronged approach targets.
Orthoses can help reduce and manage load that is causing pain and discomfort in the foot.
For straightforward cases, off-the-shelf insoles for overpronation may be all that’s needed. They’re accessible, affordable, and a sensible place to start. For more specific symptoms, greater activity demands, or specific footwear challenges, bespoke orthotics for overpronation can provide personalised support based on the individual’s presentation rather than a generic fit.
Before recommending support for your patient, it can be helpful to ask a few questions:
Instead of starting the conversation by saying “you overpronate and need orthotics”, it can be more helpful to explain that the forces acting on the foot during movement may be affecting the tissues, causing pain and discomfort.
That isn’t just a change in language; it’s a fundamental change in helping people understand why they’re experiencing symptoms and why they may continue to unless they actively choose to engage in more comprehensive treatment that treats the feet and lower limbs as the interconnected unit that they are.
Overpronation may be part of the story, but it’s not the whole story. Better outcomes come from understanding the person, their activity, symptoms, load, and goals, and not just how their foot rolls when they walk.
If you’d like clarity on the root cause of foot and lower limb pathology, and a partner in supporting your patients, MM Podiatry is here for you with orthotic prescription support.
Contact us today to learn more about our offerings.
