Pronation is an orthopaedic term used to describe the ‘rolling in’ motion of the foot and ankle that occurs during and soon after our foot contacts the ground while walking and running. Pronation is a normal component of gait and something that provides valuable shock absorption, however problems can occur when the amount of pronation is excessive, when the speed of pronation is excessive, or when the amount and speed of pronation is excessive.

In a “normal” foot the pronation forces are balanced by joints, ligaments, and muscles which help to support the foot and ankle in a health position as it progresses from heel to toe. Subtle variations in the shape and structure of the foot (‘skeletal drivers’) person to person mean that some people are just predisposed to over-pronation. Common variations that drive excessive pronation of the foot include external tibial torsion, rearfoot and forefoot varus, and hallux limitus.

The lower limb sits on top of the foot and ankle, so when the foot pronates there is an associated inward rotation of the shin bone. Variations in the shape and structure of the rearfoot (subtalar joint axis) mean that for a given amount of pronation the extent of shin rotation can vary. In those with a high subtalar joint axis even a small amount of pronation at foot level causes a significant amount of shin bone rotation, and these individuals tend to develop problems higher in the lower limb, most often at the knee. In those with a low subtalar joint axis pronation at foot level is associated with negligible rotation of the shin bone, and as such problems are generally more confined to the foot and ankle.

Gait analysis by an experienced Podiatrist can quickly pick up whether a foot is pronating abnormally or not and whether it is relevant to a given injury. If the amount and/or speed of pronation are deemed to be excessive then correction is predominantly achieved by the use of an orthotic device to dampen the forces involved and slow down the speed of pronation.

Rehabilitation of muscles in and around the foot and ankle and further up the leg at the hip can also help as they act to orientate the whole leg in a suitable position over top the foot thus helping to maintain equilibrium as the foot moves from heel to toe.