Fig. 1. pronation-supination

Physiotherapist explains foot pronation & supination

A physiotherapist explains Pronation and supination as  movements that occur at the subtalar joint of the foot. The normal biomechanics of the foot are designed to absorb and direct the forces occurring throughout the gait cycle. As the foot is loaded, eversion of the subtalar joint, dorsiflextion of the ankle, and abduction of the forefoot occur. This is the pronation part of the gait cycle. Pronation should not continue past the latter stages of midstance during the gait cycle. At this stage the foot should then supinate in preparation for toe-off. Approximately four degrees of pronation and supination are necessary to enable the foot to propel forward properly. Any increase on this four degrees brings a foot into over-supination or over-pronation.


Pronation – physiotherapist explaination

Pronation of the foot is where the heel and the little toe move away from the center of the body. The foot also dorsiflexes up slightly, the ankle rolling inwards. Pronation is part of the natural movement of the human body. Certain injuries can occur with excessive pronation.  Runners with flat feet often tend to overpronate. Over-pronation can contribute to many injuries. These include shin splints, anterior compartment syndrome, patello-femoral pain syndrome, plantar fasciitis, tarsal tunnel syndrome, bunions (hallux valgus), achilles tendonopathies etc. The running shoes of over-pronators often show extra wear on the inner heel and ball of the foot.


Supination – physiotheraist explaination

With supination the heel and also the big toe rotate towards the centre of the body. The foot flexes down and the ankle rolls out. It is the opposite of pronation. A natural amount of supination occurs during the push-off phase of the running gait. This occurs as the heel lifts off the ground and the forefoot and toes are used to propel the body forward. However, excessive supination  places a large strain on the muscles and tendons that stabilize the ankle. This can make the oversupinator more prone to ankle sprain or ankle ligament rupture.

With over-supination the forces of impact on the foot are concentrated on a smaller area of the foot (the outside part), and are not distributed as efficiently. In the push-off phase, most of the work is done by the smaller toes on the outside of the foot, rather than the big toe. This places extra stress on the foot. It can lead to conditions such as iliotibial band syndrome, Achilles tendinitis, or plantar fasciitis. Over-supination causes the outer edge of running shoes to wear sooner. In extreme cases, there will also be holes in the uppers where the runner’s foot has broken through. Runners with high arches and tight Achilles tendons/calves tend to be over-supinators.



Properly prescribed foot orthotics can be beneficial in the treatment of over-pronation or over-supination. Physiotherapists usually supply both off the shelf and/or custom made orthotics. We  prescribe these only when we really feel they are necessary. Often the much cheaper off the shelf version will do the trick. It is important to get a quality product, prescribed by an experienced practitioner. Sometimes you just have an injury that needs  treatment and there is no need for an orthotic. Also high arches or a flat feet do not mean in itself you need orthotics, especially if you are not in pain.





MetatarsalgiaMetatarsalgia is the name given to pain in the front part of your foot under the heads of your metatarsal bones ( ball of foot, just before toes). It is usually worse when standing or walking etc.  and occurs most frequently in the second, third/or fourth metatarsal joints or isolated in the first metatarsal joint. Metatarsalgia usually comes on gradually over some weeks rather than suddenly. The affected area of your foot may also feel tender on palpation by your physiotherapist.

Common causes identified by physiotherapists include:

  • Pes cavus or high arched foot.
  • Excessive pronation of the foot(foot rools inwards ie. with flat foot).
  • Clawing or hammer toes.
  • Tight extensor tendons of the toes.
  • Prominent metatarsal heads.
  • Morton’s foot – here there is a shortened first metatarsal, which results in an abnormal gait putting increased pressure on the second metarsal.
  • Over doing it in athletes such as runners and tennis players etc. can lead to inflammation in the joints due to the pounding they receive.
  • Being overweight puts extra stress on many areas of the foot including metatarsals.
  • Wearing high heels – forward force on feet increases the pressure on metatarsal area.
  • Having tightened calf muscles or poor ankle flexibility – this affects the normal gait pattern.
  • Poorly fitting or tight footwear can squeeze the metatarsal joints causing friction , inflammation and poor gait.

Simple measures can help to relieve the symptoms of metatarsalgia. These include:

  • Resting with your feet elevated where possible.
  • Losing weight if you are overweight.
  • Wearing supportive shoes that are well fitted, low-heeled and have a wide toe area.
  • Metatarsal pads and orthotic inserts for your shoes may help to relieve pain in your forefoot by reducing the pressure placed on the heads of your metatarsal bones.
  • Physiotherapy may also be helpful. This may include stretching out the spaces between the metatarsal and mobilising the joints of the foot or performing deep tissue massage to loosen your calf muscles or any other lower limb muscles that may be contributing to poor gait. Sometimes if a metatarsal head has dropped it can be manipulated back into place. Pain relief as a result of this mobilisation, when effective can be immense and long lasting.
  • Simple painkillers such as paracetamol and non-steroidal anti-inflammatories(NSAIDs) such as ibuprofen may help to relieve pain.