What Is Underpronation?

Underpronation, otherwise known as supination or rolling outward of the foot, is less common compared to overpronation or rolling inwards of the foot (flat foot). In most cases, underpronation is not a serious condition but can lead to pain and even disability in severe cases. 

Underpronation is characterized by a high arch that causes the majority of a person's weight to be placed on the outer aspect of the foot. This is typically accompanied with an outward roll of the heel when striking the ground. The arch is usually inflexible and does not depress downwards when weight is applied to the foot. Calluses can be seen along the outer edge of the small toe due to the weight being exerted on the outer aspect of the foot. Inspecting the underside of your shoe to see if the outer edge of the sole is worn down can indicate if you underpronate.



Summary of Important Points

• Weight transfer to the outside of the foot
• Noticeably high arch 
• Reduced flexibility in the arch 
• Outward roll of the heel under weight
• Worn down outer sole of shoes
• Calluses seen on the outer edge of the foot and toes



Symptoms of Underpronation

• Plantar fasciitis A burning sensation or pain felt on the underside of the heel caused by inflammation of the plantar fascia.
• Shin pain Caused by the increased pressure on the shin bone due to the rigidity of the foot upon impact with the ground. The rigidity of the arch means decreased shock absorption, putting the lower leg under increased strain when striking the ground during high impact activities like running or jumping. 
• Metatarsalgia Pain and inflammation felt in the ball of the foot under weight, usually caused by aggravation of the metatarsal joints. 
• Achilles tendinopathy Pain and stiffness felt in the Achilles tendon attaching the calf muscle to the underside of the heel, usually after exercise. Caused by increased load requirements of the first and second toes while transferring weight over the foot from the heel forward. 
• Ankle sprains Increased likelihood of sustaining ankle injuries due to the excessive outward rolling of the foot. 
• Ankle fractures Ankle fractures can occur in severe cases when too much pressure is put on the foot and ankle, such as in activities that involve jumping. 



Causes and Risk Factors of Underpronation

• Misalignment of the body Misalignment of the knees, hips, and pelvis contributes to the foot supporting weight on the outside, as seen in people with bow legs or a broad pelvis. 
• Weakened lower leg muscles Decreased activity of some muscles in the lower leg will put other muscles under strain during walking or standing.
• Genetics Characteristics inherited from parents affecting the lower leg or foot can lead to underpronation. These can include ankle instability, leg length differences, and ligament laxity or weakness. 
• Other health conditions Arthritis or gout can lead to changes in the structure of the foot, leading to underpronation. 
• Previous injury Previous injuries may result in unstable ankle ligaments which could lead to underpronation. In addition, injuries to the Achilles tendon are known to cause a change in gait, resulting in more weight being placed on the outer edge of the foot. 
• Footwear Worn or old footwear that does not provide enough support to the foot can contribute to the weight being placed on the outside of the foot. 



Conservative Treatments for Underpronation

Orthotic insoles specifically designed for feet that underpronate will support the foot through the gait cycle. The orthotics prevent the outward roll of the foot and redistribute the weight through the entirety of the foot. By limiting the underpronation, less strain is placed on the outer structures of the foot and a more neutral foot shape can be achieved. Orthotics will lessen the impact the foot experiences during running or walking through shock-absorbing materials, taking strain off the muscles, bones, and tendons of the lower leg. This will prove its worth when placed in trail running shoes and used over a fair distance. Likewise, running barefoot has also proved to cause less underpronation compared to wearing shoes. 

Shoes with a high arch support may worsen your symptoms. A neutral shoe or one designed for underpronation is an effective option that will not aggravate symptoms. 

Physical therapy can assist you in identifying the cause of your underpronation. It can also help you develop a management strategy to treat your condition with hands-on therapy and a combination of strengthening and stretching exercises. 

Exercise therapy and orthotics prove to be the best way in managing this condition, preventing the progression thereof, and improving the symptoms experienced. 



Strengthening Exercises for Underpronation

• Strengthening the muscles on the front of the leg (tibialis anterior) using forefoot raises when sitting. These are done by keeping the forefoot off the ground and placing weight on the heel.
• Strengthening the glute muscles using bridges, single leg lunges, or jump squats.
• Strengthening the inner muscles of the thigh (hip abductors) using the clamshell exercises.
• Strengthening the calf muscles using calf raises or step-ups.

Stretches for Underpronation 

• Stretching the calf muscle 
• Stretching the plantar fascia 
• Stretching hamstrings, quadriceps, and hip flexor muscles



Can Underpronation Be Treated or Prevented Without Surgery?

For the majority of cases, symptoms caused by underpronation of the foot can be managed through a combination of the ways mentioned above. This condition cannot be cured completely but rather managed well by using the correct footwear and orthotics, coupled with other conservative treatment strategies. If left untreated, hip and back pain can arise from misalignment starting in the feet. 



Should You See a Doctor for Underpronation?

You should consult with a doctor should your symptoms persist or worsen despite efforts to manage them with conservative strategies. Should excessive pain or swelling arise in the ankle or foot, consult with your doctor. 

See a doctor if you experience the following symptoms:

• Painful, numb, or stiff feet 
• Sudden decrease in standing and walking balance
• Pain in shin bone
• Pain in ankle 
• Decreased mobility 
• Excessive swelling or bruising