“Overpronation” and Foot Orthotics

I have written so many times about “overpronation” that I must now be starting to sound like a broken record. See here, here and here. To sum it up:

  • ‘Overpronation’ is a bad term. There is no consensus between what is normal and what is ‘over’.
  • The running standing of it is poor (see this)
  • There are many causes of it, so the treatment of it (if it needs treating) is never going to be one size fits all as advocated my some many who have no clue what causes it.
  • Regardless of what one thinks, the two most recent systematic reviews and meta-analyses on it have both concluded that it is a risk factor for an overuse injury. This is despite some individual studies showing that its not and other studies shows that it is – the preponderance of the evidence is that it is a problem. However, it is only a small risk factor, but still statistically significant.

In the past clinicians (including me) used foot orthotics to manage “overpronation”. Clinically, in patients it seemed to work quite well and we got reasonably good outcomes. However, with time we know from the evidence that using foot orthotics to treat “overpronation” is not supported by the evidence (and I published some of that evidence a very long time ago). What all this got to mean was that foot orthotics were working, but they were not working because they were dealing with the “overpronation”. There was some other mechanism involved.

What I am convinced it is and there is plenty of thought experiments that are consistent with the evidence, is that it is all about forces and kinetics. When we tried to treat “overpronation” with foot orthotics what we were really doing was just altering the kinetics and the forces in the tissues that were responsible for the overload that was responsible for the problems. In my Clinical Biomechanics Boot Camps, I talk a lot about thinking in terms of forces and loads rather than movement and motion when it comes to prescribing foot orthotics. Foot orthotic prescribing can be significantly improved if you think in those terms.

Leave a Reply

Your email address will not be published.