Underpronation: What is it and how can it affect runners?
If you’re unsure what underpronation is, you’re not alone. The term – also known as supination – is occasionally thrown around when you’re buying running shoes or getting a gait analysis. However, unless you’re clued up on the body’s biomechanics, there’s a good chance that you don’t know what it means – and whether or not it’s something that you need to try and fix.
The ying to overpronation’s yang, the term is used to describe the foot’s positioning during your running gait. And like its opposite, it’s no bad thing.
Although supination isn’t as common as a neutral pronation or overpronation, roughly 1 in 10 runners do it, which means that you’re not a statistical outlier if you do. But what are the next steps to take if you’ve been told that you have underpronation?
We spoke to Nick Knight, MSK and sports podiatrist and director of NK Active, to get to the bottom of what underpronation is, and whether it impacts your running and risk of injury.
What is underpronation?
During the foot strike part of your gait cycle, your foot will distribute the weight from the impact of landing in one of three ways – neutral, overpronation and underpronation. In a neutral pronation, your foot rolls inward slightly, but not so much that the load moves to the arch on the inner side – which is overpronation. Underpronation, meanwhile, sees little or no inward roll.
‘What normally would happen is that you strike on the outside, then the foot gradually moves from outside to inside,’ explains Knight. ‘What you tend to find [during underpronation] is that people strike down quite heavily on the outside of the foot. They stay on the outside of their foot slightly too long, then they’ll continue to load the outside of their foot until the last minute.
‘From a medical viewpoint, underpronation is what we call supination, so that means your foot is rolling out,’ he adds. ‘Supination and pronation are normal factors of the human gait cycle, so it’s not something that we should actually be worried about too much. In reality, there are no normative values on how much a foot should move, so the whole notion around underpronation and overpronation is a bit of a myth – it doesn't really exist.’
Knight suggests that underpronation is caused by having a higher arch, but that in general ‘you shouldn’t be worried about it at all unless it’s giving you problems’.
What are the signs of underpronation in runners?
Unless you’ve had a gait analysis or are suffering from injury, you might be completely unaware that you have underpronation. But there are a few telltale signs that you can look out for.
‘[Runners with underpronation] tend to wear the whole outside of their shoe down much quicker,’ says Knight. ‘Also, sometimes, they feel like the uppers on the shoes start to change quicker on the outside because they’re putting more load through it.’
Should runners worry if they underpronate?
If you’ve noticed that your shoes wear down on the outside, or have been told that you have supination during a gait analysis, you might be considering doing something about it. But Knight doesn’t believe that it’s a cause for concern, adding that ‘if you’re not getting symptoms, that tells me the body is coping with it’.
‘If you start getting any niggles or any minor injuries are popping up, then that’s the time we may need to look at addressing those problems,’ he says. ‘But until then, don’t worry about it – just enjoy your running.’
Is underpronation linked with injury?
It’s easy to think that your foot’s pronation must be a direct cause of injuries, particularly if you have underpronation and are putting more force through the outside of your foot.
But scientific research suggests otherwise. An observational study published in the British Journal of Sports Medicine tracked 927 Danish runners for a year, all of whom wore neutral running shoes – regardless of their pronation status. It found that those with high supination and supination were just as likely to get injured as runners with a neutral pronation, contradicting the consensus that underpronation leads to more injuries – and that it requires specialist running shoes to provide extra support and stability.
Knight suggests that while underpronation doesn’t cause injury, it can irritate an injury once one has occurred. He adds that those with supination can be more predisposed to certain injuries like lateral ankle sprains and a pain down the outside of the leg called peroneal tendinopathy, which is cause by overworking those muscles.
‘Some people who have that slightly higher arch foot type can also have a slightly stiffer ankle,’ he says. Sometimes, that can irritate the achilles tendon, but not that often.’
How can runners manage underpronation?
If you underpronate but don’t have any injuries, Knight says that the top thing to do is .
‘Making sure that you’re doing regular lower limb strengthening exercises and maintaining your calf flexibility are most probably some of the best things that you could do for this,’ he says.
In terms of footwear, he recommends a shoe with a rocker – ‘just to help push forward through the gait cycle and have a bit more cushioning’ – to those with higher arches, but stops short of recommending orthotic insoles.
‘That’s only needed if you’ve got a problem – you don’t need them as a preventative measure.’
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