Quick Guide: Supination (Underpronation)

What is Supination?

Supination is the outward roll of the foot during normal motion. In supination, the weight is placed more on the outside of the foot rather than evenly distributed across the entire foot. Reduced Shock Absorption. The lack of inward foot motion during walking or running means that the foot doesn't effectively absorb shock. This may contribute to joint pain in the knees, hips, and lower back due to the additional stress placed on these areas.

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How to Identify:

Observation of Your Footwear:
- Examine the wear pattern on your shoes.
  - If the outer edge of your shoes shows more wear than the inner sole, this could indicate that you're supinating.
  - Supinators tend to push off from the outer edge of their foot, causing increased wear on the lateral (outer) side of the shoe.
Wet Footprint Test:
- Wet your feet and step onto a flat surface like a piece of paper or towel.
  - Look at the shape of your footprint:
    - If you have a high arch with little contact between the inner part of your foot and the ground, you're likely a supinator.
    - A normal foot arch will leave a more even footprint, while someone with flat feet will show a broader footprint.
  - If there's little or no impression in the inner part of the foot (especially the arch), it's a sign of supination.
Mirror or Video Walking Test
- Walk barefoot on a hard surface while looking in a mirror or recording a video from behind.
- In supination the foot will remain on the outer edge without rolling inward much.

Effects of Supination

Increased Pressure on the Outer Foot:
- Supination causes more pressure on the outer edges of the foot, which can lead to discomfort or pain in the toes, heels, and the outer side of the ankle.
Increased Risk of Injury:
- Supinators are at a higher risk of developing injuries such as sprained ankles, stress fractures, or shin splints. The lack of proper shock absorption increases the chance of stress on the joints and bones.
Inefficient Gait:
- Supination can result in an inefficient gait pattern, leading to fatigue and increased wear on certain parts of the foot, which could worsen over time.
Foot Deformities:
- Over time, supination can contribute to the development of foot deformities such as bunions, hammertoes, or calluses due to abnormal pressure distribution.
Consult a Specialist:
A professional can assess your gait and foot mechanics to determine whether you supinate. They may analyze your walking pattern using specialized equipment or conduct a physical exam to check your foot's structure and movement.

Causes of Supination:

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Genetics:
- Some individuals are naturally predisposed to supinate due to their foot structure, such as having high arches. High arches prevent the foot from rolling inward to properly absorb shock.
Weak or Tight Muscles:
- Weak muscles, particularly in the foot and lower leg, can contribute to supination. Likewise, tight muscles, especially the calf muscles, can also restrict the foot’s natural motion.
Improper Footwear:
- Shoes that lack sufficient cushioning, support, or stability can contribute to or exacerbate supination. For example, shoes with high arches that don’t provide enough flexibility or shock absorption can increase the outward roll of the foot.
Previous Injuries:
- Past injuries to the feet, ankles, or legs may alter the gait and lead to compensatory supination, as the body adapts to a new pattern of movement to avoid pain.
Structural Issues:
- Structural imbalances such as differences in leg length or misalignments in the hips or knees may also contribute to supination.

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Corrections for Supination:

Proper Footwear:
- Choosing shoes designed for supination can make a huge difference. Look for shoes with:
  - Cushioned insoles for shock absorption
  - Arch support that helps evenly distribute pressure
  - A wider base or slightly curved soles to promote proper alignment - frequently called a “Neutral Shoe”
Orthotics:
- Custom or over-the-counter orthotic insoles can help correct the foot's position by providing additional support and cushioning, redistributing pressure across the foot.
Strengthening and Stretching Exercises:
- Strengthening exercises for the foot, ankle, and lower leg can help correct muscle imbalances that contribute to supination. For example, calf raises and toe curls can build up the muscles needed to stabilize the foot. Stretching tight muscles, particularly the calves and Achilles tendon, can also improve flexibility and help control supination.
Physical Therapy:
- A physical therapist can assess your gait and help you with specific exercises and stretches tailored to correct supination. They may also suggest adjustments to your posture or gait during activities like walking or running.
Proper Walking and Running Technique:
- Working with a professional to improve your walking and running technique can help reduce the risk of supination. This may involve changing your stride or focusing on better foot placement while moving.
Addressing Structural Issues:
- If supination is due to a structural imbalance such as leg length discrepancy, a healthcare provider may recommend specific treatments like shoe lifts or alignment adjustments to correct the imbalance.