Overpronation: Accurate or Out of Date Terminology?

Sep 22, 2012   //   by Ian Griffiths   //   Strength And Rehab For Endurance Athletes  //  39 Comments

I’ve written this article to specifically discuss some of the literature regarding foot level pronation, and in doing so facilitate the conclusion that the term “overpronation” is neither accurate, descriptive nor meaningful, and should therefore be erased from modern day usage in both the lay and the medical communities.

Background

Pronation is simply a description of a normal joint movement.  Whilst this article is referring to this motion in the lower limb, it is worth remembering that pronation is not isolated to the lower limb; the upper limb can of course also pronate – this occurs at the distal radioulnar joint in the wrist (when checking your watch to see what the time is for example).  At foot level, pronation is seen as a combination of abduction, eversion and dorsiflexion (when weightbearing) and this motion occurs primarily at the subtalar joint, which is the articulation between the talus and the calcaneum (heel bone).

Normality?

Traditional Gait AnalysisThe theoretically conceived reference for an ‘ideal foot’ is essentially still what many modern day biomechanical evaluations and management plans are dependent upon despite the fact that this paradigm was first introduced in the early 1970’s.

Feet which did not fit stated criteria were deemed as ‘abnormal’ with the assumption being that they may be less efficient and more prone to injury due to compensations which may occur during activity.

Somewhere along the line, this information evolved into what became the cornerstone of most educational programmes on foot function; that we should function either in, or very close to subtalar joint neutral (the position when the subtalar joint is neither pronated nor supinated).

It should be noted that this has never been suggested in any research, instead just gaining popularity within both medical and lay communities insidiously.

Studies have shown that the structural anatomy of the human subtalar joint varies from person to person and it has also been shown that the location of the axis of the joint can and does vary from person to person; this will of course directly influence the magnitude of pronation and supination seen.  In light of this sort of evidence it seems odd that there would be an expectation that all individuals could or should function similarly or identically.

Across many studies, all of the data collected from pain free and injury free subjects and athletes shows that very few individuals actually meet the historical definition of ‘normal’.

One study examined 120 healthy individuals both non weight bearing and weight bearing. Not one subject conformed to the historical criteria of a ‘normal’ foot. Further searching through the literature shows that the majority of data collected from sampled populations suggests that the normal (average) foot position at rest is actually mildly to moderately pronated, as opposed to ‘neutral’.

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Measuring static pronation

Considering the many different ways to quantify foot level pronation, there is actually no agreement on the best way of examining static subtalar joint pronation.  Clinical measurement of foot position is renowned for being challenging due to the complex interactions of the many joints involved.  What is clear is that irrespective of the measurement method chosen, the reliability of such measurements is found to be poor to moderate, at best.

With respect to finding the subtalar joint neutral position, even experienced Podiatrists are only within 3o of subtalar joint neutral 90% of the time as shown by a Canadian study. Another issue to consider with static measurements of pronation is that there is some disagreement as to whether they are associated with dynamic foot function, with growing evidence that there is little to no relationship between the two.  Indeed many Podiatrists have ceased clinically quantifying these measurements for all of these reasons.

Injury

It is a commonly held belief that pronation will increase the risk of lower extremity injury.  However (perhaps surprisingly) this is not particularly well supported by the literature, with very few studies which actually show pronation increases injury risk.  Instead, there are numerous pieces of work which have shown there is no association with foot type and injury and some research exists which even suggests that a pronated foot type is actually protective against injury.  This is not to say that some individuals will not suffer with pain or discomfort which may be associated with their foot motions or pronation patterns, but what is certainly clear is that the relationship between pronation and injury is poorly understood at this time and is far from consistent or predictable.

Summary

The available research points to the following conclusions:

  • It is difficult to accurately and repeatably measure foot level pronation
  • The relationship between pronation and injury is very poorly understood
  • The historical concept of ‘normal’ is erroneous
  • Variation between people in foot level movement patterns is high (and this is normal)

What does this mean for “Overpronation”?

Overpronation is often used to describe a foot which is in a pronated position, but considered to be ‘too pronated’ or ‘more pronated than normal’. It is also generally referred to in a negative way, in that it will often be considered to be pathological and in need of ‘correction’.  It is even used by some as a diagnosis.

Ambiguity

A golfer has just hit a shot 150 yards.  Have they “over” hit it? To correctly answer that question you would need to know exactly how far they were supposed to hit it or what they were aiming for…

In order to be able to confidently state that something is happening too much, then by definition we must be comparing it to how much it should happen.  Hopefully what has become clear by now is that we do not know how much pronation is ‘normal’. All we do know that it will likely be different from person to person (and of course activity to activity).  Essentially, we do not necessarily know what we are aiming for in a given individual, so how can we say when it is “over”?

Use as a Diagnosis

In addition to the now obvious ambiguity of the term, the use of it as a diagnosis is most certainly to be discouraged.  Many individuals present to clinic with the information that they have been previously diagnosed as an “overpronator”.  As mentioned earlier, pronation is simply a motion – an observation, but never a diagnosis.  Imagine two different athletes present with feet which appear to function in a similar manner, and it is noted they are both in a maximally pronated position. Athlete 1 complains of pain on the inside of the ankle.  Athlete 2 complains of pain on the outside of the ankle.  How could they both be diagnosed with the same “condition”?  Grouping all foot and ankle pains into one convenient ‘diagnosis’ is at best ill-informed, and at worst is delivering a care below the standard of that which athletes deserve.

Use as a Scapegoat

The majority of athletes presenting to sports injury clinics across the globe will already be injured.  As the aforementioned research has shown, normative data suggests that most individuals have a mild to moderately pronated foot type (rather than a neutral alignment which is erroneously thought to be ‘normal’).  Therefore whilst it has often been assumed that foot posture may be one of the contributing factors in a presenting lower limb injury (which of course it may well be for some), the subtle differences between causation and correlation should always be kept in mind.  Just because a foot/lower limb which hurts is pronated, does not mean that it hurts because it is pronated.  This is why a thorough history of the mechanism of the presenting injury and all other potential contributing factors are just as important as foot posture, and should be concurrently investigated.

“Overpronation” and management of injury

So does “overpronation” help formulate treatment plans for injured individuals?  In the fictitious athletes mentioned above, how does classifying or terming them to be “overpronating” guide a clinician in treating them?  It could be argued that doing so and treating them both in a similar manner (increasing subtalar joint supination moments for example) may achieve a desirable result.  However looking at a foot position, attaching a vague and meaningless term to it, and then initiating a blanket management plan which seems to be the same irrespective of the exact problem is very bad science at best, and at worst could be considered grossly negligent.

So if not “overpronation” then what?

A fair question may be that if we are to abandon the term “overpronation” then what do we use in is place?  The answer to this is: nothing.

Hopefully it is now clear that this is a term which contributes nothing to our understanding – it is not definable, not reliable or valid, not diagnostic, its relationship to injury is not fully understood, and it does not dictate what the most appropriate management plan may be.  It should not be replaced, it should be removed.  A more appropriate way to move forward with respect to assessing and treating injured individuals is to accurately identify the injured anatomical structure (formulate a diagnosis), identify the structural and functional characteristics of the foot and lower extremity, determine the most likely type of tissue stress which is causing the pathology, and then design the management plan to reduce these stresses and optimise gait function accordingly.

About The Author

Following completion of his BSc (Hons) degree in 2003 Ian worked for the NHS for 3 years. In 2006 he began working in private healthcare clinics across the City of London and Harley Street. In January 2010 he became the full time Director of Sports Podiatry Info Ltd and now provides a high level service from private clinics in Essex and London.

Ian has experience with a vast range of patients from the recreational runner completing their first marathon right through to professional international footballers and golfers. He has obtained a postgraduate certificate in Sports Podiatry, and has also completed his Masters degree in Sports Injury at Manchester Metropolitan University, where he was awarded a distinction for his research into supination resistance.

His main interests lie within the fields of gait analysis, biomechanically induced tissue stress, and the application of engineering principles to human structures. He firmly believes in an interdisciplinary approach to injury management and is fortunate enough to have worked very closely alongside Sports Physiotherapists for the last 6 years.

Visit Ian's blog: Sports Podiatry Info.
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39 Comments

  • Great article. Far more important than the position of the foot is can the foot load into pronation and then get back out and go through supination. As long as it can load and unload the actual position of the foot is of little relevance. A pronates foot may still be able to go through pronation and a nuetral foot may not. Assessing the movement of the foot in a load bearing position is far more important than assessing it off load and comparing it to an ideal position.

  • Hi Ian.
    I enjoyed the article. There are a few points I want to get your thoughts on. I agree with you that the over pronation paradigm as it exists is flawed. I still think investigating the amount of pronation has some merit for injury treatment and prevention. I know the research is not convincing, but I can rationalize how aberrant joint motions could create biomechanical issues. A big problem I see is that being a tri-planar motion, pronation is difficult to measure. It would be a lot easier to measure the component joint motions separately and use those numbers as a basis for determining how each contributes to injury risk. Do you think this might yield a better understanding of foot mechanics and injury?

    I agree that dynamic measures rather than static measures should be used. When looking at normative data though, how many of those studies take into account the influence habitual footwear has had on joint mechanics? A shoe wearing population might show altered foot posture or mechanics from adaptations that occured as a result of shoe wear.

  • Very good article Ian,
    I’m happy to see a podiatrist pushing the reflexion further. I defend these positions since 10 years (trough a running course I’m teaching) and I have a hard time with most of health professionals. I think the trend of dynamic valgus at the knee will follow exactly the same path. 1. idea we need to be straight-align 2. define a normal that doesn’t exist 3. validate with cross-sectionnal studies (correlation) 4. doing interventions (some harmful like surgery… other less like exercises) … and finally having some prospective studies that NOT show a causation… and for a few people : changing there own practice.
    Blaise

  • Very well written piece. Despite the amount
    of overpronation being considered is possibly
    less relevant that we once thought, I think there is
    still an issue of rate of change between overpronation
    and supination, and its here that I think the considerations
    to the movement need to be based. I think tissues don’t
    like sudden loading/unloading at high speed and some can’t cope
    When u add volume of activity to it eg long distance running.
    At a clinical relevance level, maybe that’s how corrections made help, a albeit difficult to measure without some kit.

  • Ian:

    I liked the article. However, we do see patients who appear to pronate excessively during running or walking, appear in our clinics with symptoms that seem to be related to excessive subtalar joint pronation moments, and then their symptoms improve and their excessive pronation motion also seems to improve with treatment of their symptoms and abnormal gait function with custom foot orthoses and appropriate shoes. I know that both you and I and thousands of clinicians also see this on a regular basis.

    What then, in the example above, would you suggest we say to another clinician and to the layperson was the cause of their symptoms?

    Keep up the good work, Ian.

    Cheers,

    Kevin

  • The concept of overpronation is an interesting one, but I often wonder why the foot/ankle complex is showing this movement pattern. This ties in with your conclusion.

    Foot movements can not and should not be viewed in isolation and I believe you are correct when you talk about assessing the whole lower extremity. Where I would differ from you is that I would also include pelvic, S/I and possibly also low back activity as well.

    It may be possible to implicate rotation from the hip, gluteal activation patterns and also reduced movement in the S/I and low back in causing an adaptation at the foot. If that is the case “correcting” the overpronation can and does just cause problems else where.

    So as you rightly say overpronation becomes the scapegoat for another problem, or maybe rephrasing it slightly, you end up treating the symptom not the cause.

  • Hi all,

    Apologies for not responding to feedback earlier; I have been a little caught up with preparing for a presentation I am due to give soon. I did however just want to briefly clarify my position in response to some of the above comments.

    - I still believe considering the magnitudes, timing and velocity of external subtalar joint pronation moments is a key part of any assessment of an athlete.

    - Despite the scant prospective research to back it up (as discussed briefly in the article), I do see pathology on a daily basis (as does Kevin and numerous other clinicians I am certain) which I believe to be related to, or caused by, increased external subtalar joint pronation moments.

    - I do also, however, not believe that foot level pronation will cause problems for all of the people all of the time. The article was more a narrative on the way I see terminology used here in the UK. I stand by my comments that the word “overpron….” (I can barely bring myself to even type it) is of little use, and could/should be abandoned.

    All in all, I am glad that the article has generated some debate and discussion on this very interesting topic, and hope people enjoyed reading it. None of us have all the answers but it sure is a fun journey anyway.

    All the best

    Ian

    • Hello Ian,

      your sentence “- I do also, however, not believe that foot level pronation will cause problems for all of the people all of the time. The article was more a narrative on the way I see terminology used here in the UK. I stand by my comments that the word “overpron….” (I can barely bring myself to even type it) is of little use, and could/should be abandoned.”, is exactly what I think.

      To be honest, I think if a person (runner, for example) has a good basic conditioning, has a progressively oriented training, and has a lot of pronation (whatever that means) she can go without pain. Another situation, if the same person doesnt have the same conditioning or training, she can have “overpronation” injuries. What I mean is that there are many, many factors that contribute to the development of an injury. Excessive pronation (whatever that means) can be a contributing factor but not the only one.

      Cheers,

      Claudio

  • I’m a wholehearted supporter of “#formbeforefootwear” and totally agree that wearing a trainer to overcome a bio-mechanic inefficiency is not a long term solution. However, I find the suggestion that we erase the term “over-pronation” slightly confusing. Maybe this is becaise of the way in which I was originally taught & understand the term. Pronation is indeed a natural series of muscle contractions & resulting joint motion that needs to occur each time a limb(s) lands in order to decelerate the body prior to the next acceleration (supination), but if this series of contractions is not optimised, e.g. made inefficient by muscle weakness, hence causing the body to remain in the pronated decelerative state for too long, then surely this is a case of OVER-pronation and once diagnosed can be treated by adjusting (stretching / strengthening) the kinetic chain as and where necessary? I look forward to comments. A very healthy, enjoyable and informative debate. Thanks, @sportinjurymatt

    • Hi there Matt
      I have been involved in Coaching for over 25 years also qualified in sports injury therapy and have a degree in sport science, having had quite a succesful time as a 400 metre Hrdler over a period of some 15 years i found there was a pattern to certain injuries which was being caused by over pronation, i dont want to be contraversial but it does seem that people do not use much in the way of common sense when assesing why athletes have repetative strain injuries.

      It was mentioned what is the correct position for the foot whilst striking the ground, yes we are all built differently but our bio mechanics should still be the same within a set degree of rotation on ankle joint.

      My point is based upon the stress loading placed upon hip and knee joints should the ankle joint be in a pronated state, by correcting this by way of orthotics i have had great success in curing athletes injuries, and i am not just talking minor injuries in 1 or 2 cases, this is more common than people care to admit.

      The easiest way to asses a patient in my humble opinion, is to ask to see the wear pattern on their everday shoes also their training shoes, this will tell us everything we need to know, couple this with the injury and point of stress, we have a simple answer and simple remed.

      Dont you think that we are over thinking the point of sport science, to much knowledge and not enough hands on experience.

      Keep up the great articles always makes interesting reading, hope you will appreciate my points, kind Regards

      Viv Rees
      Elite Sport Performance

  • [...] The reality is that pronation is completely normal. If you walk in a shoe store and their sole basis for choosing a shoe for you is how much your pronate and what your arch looks like, turn around and walk out the door. You’re probably just as well-off choosing a shoe at random from an on-line store. The science simply does not support this protocol (I wrote an entire chapter in my book explaining why), and in fact may contraindicate this practice. Given this, I was pleased to see a post come across my blogroll by sports podiatrist Ian Griffiths. [...]

  • @sportsinjurymatt I can see where you’re coming from, but in a friendly way I’m going to disagree with you.

    The part about supination and pronation being natural movements (or description of natural movements) absolutely no argument with you, but when you describe overpronation as a diagnosis I have to disagree.

    Overpronation rarely causes problems problems at the subtalar joint, so what is the diagnosis? It may contribute to problems in other areas. Plantar fasciitis may be an example of this. In which case the plantar fasciitis is the diagnosis.

    You could label overpronation as a predisposing or maintaining factor or as a clinical finding, but then why not label it just as that hypermobility at X joints?

    The start of my comment uses the words argument and disagree. I didn’t want to use those words as they sound too confrontational, but couldn’t think of a better way of expressing it in a few words. As you said “I look forward to comments. A very healthy, enjoyable and informative debate.” And I have to say I’m 100% behind that.

    • Hi Daniel. Thanks for the reply & educated comments.

      For me, the link between “overpronation” and specific problems at the subtalar joint is only half the story (although I would be curious to see if there is a direct relationship between overpronation and inhibited speed/skill/agility). More significant for me is the fact that the overpronation is just part of a lower extremity movement impairment syndrome that typically also includes increased knee valgus (tibia ext.rotated & femur int.rotated & adducted/knock-kneed) and increased extension or flexion at the lumbo-pelvic-hip-complex during functional movements.

      For me, a client that exhibits all of the above is an “overpronator” and in the majority of cases their sports performance would be hindered as a result. It would also most likely be accompanied (eventually) by a cumulative injury cycle from which the client would struggle to break from without taking steps to address the cause(s) of the overpronation and correct them.

      If this debate is defining “overpronation” as solely what happens at subtalar joint level and its causative effect on injury to just the ankle and below, then I agree the term is worthless. However, for me overpronation concerns the whole kinetic chain and therefore remains a valid term.

      I hope that explains where I am coming from and encourages more debate. :-)

  • Daniel, I agree that in clinical practice we are better off looking at and addressing the factors that cause over pronation, instead of, like Ian said, using it as a diagnosis to assign a blanket treatment. The way I interpreted sportinjurymatt’s comment is that observing over pronation in an injured patient can be helpful in determining what other exam findings might be relevant to the person’s complaint or actual diagnosis and therefore can be valuable in establishing a treatment plan.

    In regard to injury risk, I’m not convinced that we should abandon the concept of addressing excessive pronation as a preventative measure either. Certainly more research needs to be done in this area to determine 1. how to best measure pronation 2. at what level or degree (if any) does it pose an increased risk and 3. what structures or movement patterns cause pronation to exceed that level. Obviously it is difficult to establish causation but that’s not a good reason to stop scientific inquiry. I would like to see more motion analysis studies done on athletes under conditions in which an injury is likely to occur.

  • Hi Matt and James

    First Matt. I’m in complete agreement with you. You have obviously thought about overpronation as a symptom as part of a chain of structures and the effect that has on function of the body as a whole. The problem is a lot of people don’t think that way. They just see the Overpronation in isolation as THE diagnosis. The treatment/management then focuses on that only. That narrow focus is why I think it should be scrapped. I would hope (in vain?) that this then may encourage the trainer and therapist to think wider (the same way we do). There’s loads more I could add, but I really do believe we are in agreement. When I find the time I may have to write a post on this as it’s really got me thinking!

    James (nice to meet you). I agree we should never stop looking and questioning and measuring.
    Point 2 is an interesting one if I look at it my way (osteopathically?). I would say that over/hyper/excessive pronation isn’t the problem and as such doesn’t pose a risk. The risk comes from other structures, when they run out of ability to compensate for the pronation. The trouble is, this will vary from person to person and finding the danger degree of pronation would really be an individual equation.

    (degree of pronation)+(degree of tibial torsion)x(Q angle) all over length of tib+femur

    I’ve made up the formula, but that is what the individual danger angle equation would have to consider (and more). Then once you’ve measured and worked it out you’d go and treat the whole chain anyway! :-)

  • Apologies for the link… Can’t find a way to copy and paste the quote from Runblogger’s blog. Pleased to hear that Pete agrees use of the word in high street shops is the issue, not the word itself: “I don’t think the term overpronation should disappear as a clinical diagnosis, but I don’t think…” — Pete Larson http://disq.us/8bl669

  • Hello all,

    Apologies again for my lack of involvement in the discussion over the last week, but I had a little free time today so caught up with some of the comments since my last post and just wanted to respond with my thoughts on them:

    - Whilst my thoughts are also very much in sync with James regarding running technique (#formbeforefootwear) I think it is inaccurate to unequivocally state that trainers to overcome “biomechanical inefficiencies” are not long term solutions. For some they may be the only solution to pain/injury free running. For others they may require a specific shoe + foot orthosis combination to be able to achieve their goals.

    - I think simplifying foot level kinematic and kinetic patterns into “pronation = deceleration, supination = acceleration” is erroneous and inappropriate.

    - There is no link in any of the literature that I am aware of between pronation (“excessive” or otherwise) and performance impairment. There is of course also scant prospective research showing a causal relationship with injury. However, we intuitively suspect that for some of the people some of the time that the above issues may be very real. Our jobs as skilled clinicians are to therefore be very individual in our approaches to our patients, rather than apply blanket theories and/or terminology within our management of them.

    - I find it interesting just how many people have commented (via facebook/twitter or personal emails to me) on my article and used it in the context of running shoe shops and the way they recommend shoes or the running shoe industry in general. This article mentions neither of those things, and was not written in reference to them in any way.

    - I enjoy reading Pete Larson’s blog, and find my thoughts and his are often aligned. However I strongly disagree with him that “overpronation” is a clinical diagnosis. IT IS NOT. Examples of clinical diagnoses include: Medial Tibial Stress Syndrome, Plantar Fasciosis, Flexor Hallucis Longus Tenosynovitis, Achilles Tendinopathy, Calcaneocuboid joint synovitis. Interestingly those 5 diagnoses can all be commonly seen in feet with increased STJ pronation moments – further highlighting that seeing a foot and tagging it with a term such as “overpronation” is utterly pointless and about as far away from being diagnostic as it possibly could be.

    Thanks all

    Ian

    • Hi Ian. Thanks for your reply. With reference to your comment “I think simplifying foot level kinematic and kinetic patterns into “pronation = deceleration, supination = acceleration” is erroneous and inappropriate” I think this may in a nutshell why I our view of pronation and therefore overpronation differs. Having studied with the National Academy of Sports Medicine, I shy away from viewing anything at just “foot level”. Simple it may be but I find the concept that pronation is the physical action of the body’s kinetic chain to decelerate a very strong foundation on which to explain movement pattern. The action at the subtalar joint is only half the story, as outlined in the following article: anyhttp://tinyurl.com/d32yd6f
      I agree with you that over pronation should not be referred to as a diagnosis but in my case foe the reason that it surmounts to a movement pattern not a medical condition.
      I look forward as always to replies.

  • [...] of running, I came across this article discussing how the theory of “over pronation” is a myth.  That everyone can run in [...]

  • Ian,

    As a non-clinician, my statement that it was a diagnosis was not what I meant – poor wording on my part. What I intended was more that we should not ignore “overpronation” as a potential factor (clinicl finding perhaps?) that might be causally related a diagnosed condition such as the ones that you mentioned. So in effect I think we are in agreement :)

    Given your pointing out of a lack of mention of shoe shops here, do you think the term should be applied in shoe shops? This topic has obvious relevance to a lot of people.

    Pete

    • “…we should not ignore “overpronation” as a potential factor (clinical finding perhaps?) that might be causally related a diagnosed condition such as the ones that you mentioned. http://www.kinetic-revolution.com (http://s.tt/1qib2)”.

      - Well put. I agree.

  • [...] know what neutral as a category means (or that neutral has any meaning for the foot either – read this post by Ian Griffiths for more on this). Some neutral shoes are so soft that they cave medially and cause the foot to pronate way more [...]

  • Hi Matt,

    Thanks for the on going discussion. Our views on pronation do not differ as much as you may think. I am of the opinion it is a movement pattern. I am of the opinion it does not happen in isolation. I too would never look only at the foot. It would be foolish for anyone to do so given the growing body of evidence which suggests proximal muscle dysfunction is a significant risk factor for lower extremity musculoskeletal injury. The able clinician should also not ignore the concept and potential importance of lower extremity joint coupling (and the likelihood that this may be both activity and subject specific). As the researchers still can’t all agree what direction the ‘power flow’ actually goes in with respect to the relationship between kinematic patterns at foot level and lower limb rotation, it is fair to say there is still much to do for all of us in furthering our understanding of dynamic foot and lower limb function.

    Whilst I do not disagree that various extrinsic foot musculature will undergo both eccentric and concentric contractions throughout the gait cycle (and therefore will have acceleratory and deceleratory influences on joint moments) I still stand by my statement that to generalise pronation as deceleration and supination as acceleration is an oversimplification. Regarding the blog which you linked to by way of reference – with respect it is full of inaccurate and wrong statements and does not stand up to scientific scrutiny whatsoever. I am all in favour of keeping things as simple as possible (especially when talking to our patients/athletes) but within the scientific and professional arena and when talking to each other we should be more deeply investigating exactly how the foot actually does work (which none of us fully understand yet) rather than perpetuating what we were taught 10 years ago; that is not the way we will advance our understanding of this fascinating subject. If we do use mechanics/physics terminology such as acceleration and deceleration then we need to be highly specific regarding what we are actually talking about – and the way forward is not to view the foot as one rigid body, but instead to use multi-segment foot models which take into consideration the translations and excursions of each individual segment with reference to one another. See this article for what I believe to be the best piece of work published to date regarding dynamic foot function: http://www.sportspodiatryinfo.co.uk/images/docs/nester09.pdf

    It is this paper that I feel most strongly reinforces the point I was trying to make in my original article. A point which I feel may have been missed, and which we have even slightly diverted from in our discussions/comments since. So let’s get back on track. I do not discount that increased magnitudes of external pronation moments (and the associated lower extremity joint coupling – whether that be cause or effect) may be a contributory factor in lower extremity musculoskeletal injury for some of the people some of the time. I even refer to this in my original article. That has never been my argument. My argument has been the use of the term “overpronation”. It is just terrible terminology. If you cannot tell me how much pronation is normal/optimal for a given individual performing a given task (which you can’t) then by definition you cannot state what is “over”. End of story. Whether it is a term being used as a diagnosis (which you now agree it shouldn’t be) or a term used as a description for an observed movement pattern doesn’t make a difference – it is still not appropriate or correct terminology.

    When the medical community first begin to see evidence that there was no inflammatory component to “tendinitis” it did not change what they observed clinically. However it did change the terminology used, as the most current evidence at the time did not support the use of the suffix “itis”. Think of what I am saying as the same. What we observe clinically is no different. But the most current evidence does not justify or validate the use of the prefix “over”. Hope this makes my position more clear.

    Pete – you are right, we are in agreement (as the above explains). However in answer to your question “do you think the term should be applied in shoe shops?” I would say absolutely not. My dream is a day when I never hear nor read the word ever again.

    • Hi Ian,
      Thanks very much for the time you have taken to reply to me.
      Having read the article you kindly linked from the Journal of Foot and Ankle Research, I now have a far better understanding of where you are coming from. A very educative piece indeed and one from which I will definitely learn from.
      In order for us to teach, learn and seek suitable remedy, I would suggest there is always a need to apply models and criteria for the “ideal” or “normal”. This in itself separates “science” from “philosophy”. I now understand that the more recent studies you have highlighted are suggested that the “norm” traditionally used to evaluate foot function, one that as you quite rightly pointed out I learnt over 10 years ago, may soon need modifying.
      It does lead me to wonder whether the whole notion of setting “norms” for the human body will one day need modifying – but maybe that thought at least for the moment should stay in the halls of philosophy.
      Thanks for educating me Ian,
      Matt.

      p.s. On the subject of progression of terminology, I imagine you have already seen and enjoyed this piece: “Terminology And Classification Of Muscle Injuries In Sport: A Consensus Statement” British Journal Of Sports Medicine: http://bit.ly/WqOEEY

  • [...] Full Article HERE [...]

  • [...] da je zapravo pojam nadpronacije ili overponacije izmišljen i da nema nikakve veze sa povredama. Po ovoj teoriji, ovaj pojam se pojavio u širokoj upotrebi samo zbog toga da bi se proizvodili specijalni ulošci i [...]

  • [...] your mind of terminology. Over pronation (a rolling in of the foot as you run) is a term often  bandied about by apparently credible [...]

  • Great article, feel like its a never ending battle to educate people about pronation! How many people bother to go further up the chain to the hips and full lower limb mechanics? The reason I like your page so much is for all the great hip exercises on display!

  • It’s interesting to see how gradual acceptance of reduced relevance of degree of pronation at the STJ is now leading to the emerging concept that in choosing athletic footwear people should just buy whatever feels the most “comfortable”. Bit of a jump I say, but keen to hear what other people think…

  • [...] Griffiths, Ian: “Overpronation: Accurate Or Out Of Date Terminology?” 22/09/2012 http://www.kinetic-revolution.com/overpronation-accurate-or-out-of-date-terminology/ Share this:TwitterFacebookLike this:Like [...]

  • [...] Intressant artikel om skador och pronation; http://www.kinetic-revolution.com/overpronation-accurate-or-out-of-date-terminology/ DS. Share this:TwitterFacebookLike this:Like Loading… This entry was posted in Löpning, [...]

  • Hi Ian. Excellent and very informative article. As you mentioned for some people some of the time their level/degree?? of pronation can be a factor that contributes to pathology such as the five you commented on above. I am just wondering in these examples how or whether you quantify this degree/level??? of pronation?

  • Hi Ian, great article!

    I wonder if youve had a chance to study barefoot runners versus the same runners shod?

    Over the last few years, Ive had all kinds of problems with feet and shoes, conventional wisdom suggests that I need a shoe with loads of support and cushioning. However, training barefoot has left me convinced that every personal trainer and sports therapist is working with outdated information. Im glad to read the work of a professional who agrees that at least some of this conventional wisdom is invalid.

    Thanks,
    Mike

  • I now understand that an absolute measure of pronation reveals as much about your foot health as your weight measure alone reveals about your level of fitness.

    With a little bit of additional information, however, it can be determined if someone is overweight of underweight, and with that, if they need to gain or lose weight.

    How could an everyday jogger or sports player experiencing foot pain determine if adjusting pronation could yield benefits? How to determine if you need to increase or reduce pronation? Lastly, what would you call the underlying condition of someone who experiences improvements from pronation adjustment (i.e. using insoles or motion control shoes)?

    Thanks

  • […] One of our most popular guest blogger articles ever was written by Ian, challenging the use of the term ‘Overpronation’…Read the full article […]

  • […] What is ‘over-pronation’? The truth is nobody knows! There has never been a definitive answer In terms of whether larger amounts of pronation increase injury risk, It’s difficult to prove cause and effect and quality, prospective studies (the most valid way to determine injury risk factors) are severely lacking. Here’s an exert from an excellent article by podiatrist Ian Griffiths: […]

  • […] The full post can be read here a thttp://www.kinetic-revolution.com/overpronation-accurate-or-out-of… […]

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