Why do my feet go inward when I walk?

Pronation is the normal flexible motion and flattening of the arches of our feet that allow them to adapt to ground surfaces and absorb shock when we are walking normally. In a proper stride, the foot should roll forward from heel to toe and pronation should be neutral. Your weight should be balanced on your feet.

But when our foot either leans outward (supination) or inward (pronation) to an excessive degree, the continued misplaced stresses can lead to various injuries.

Excess supination

When your foot leans outward, it causes stress on the outer side of your foot when you walk or run. Your shoes will show this with wear on the outside part of the sole.

Excess supination can cause strain on your ankles. It can lead to shin splints, calluses, or bunions on the outer side of your foot. You can have pain in the heels and balls.

Excess pronation

Excess pronation, or overpronation, is more serious and leads to more injuries. When you overpronate, your foot rolls inward and your arch tends to flatten. You will show wear on the inside of the soles of your shoes.

Excess pronation can lead to pain in the arch, heel, ankle, shin, knee, hip, and back. It causes an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone.

Both excessive supination and pronation can lead to ankle sprains, heel spurs, plantar fasciitis, metatarsalgia, tendinitis, and even joint injuries.

Treatment

If you have excessive pronation or supination, we need to see you at one of our Foot & Ankle Clinics of Utah. We’ll analyze your gait and find out where the problem lies. The goal is to simply balance your feet to create proper loading when walking and running.

Treatment may be as simple as custom orthotic insoles to correct your misalignment. If one leg is a bit shorter than the other, a heel lift can remedy the problem. Physical therapy may be necessary. We’ll also recommend the right type of shoes. For instance, excess supination needs cushioning, flexibility, and support in the heel to balance the outward roll of the foot. Excess pronation needs a more stable shoe with a firm midsole and heel cushioning.

If you’re dealing with the daily pain that could be due to issues with supination, please give us a call at any of our five locations in American Fork, (801) 763-3885; Payson, (801) 765-1718; Springville (801) 491-3668; and Orem (two locations, (801) 226-2421 or (801) 765-1718).

Pronation is the natural motion of your foot during walking and running. Your gait can show a pattern of neutral pronation, overpronation, or supination (underpronation). Overpronation occurs when the way you walk leads to more flattened arches over time causing tension in your foot and leg muscles. The stresses of overpronating or supinating have been linked to a greater risk of injuries. 

Motion-control shoes and orthotics may be recommended if you are an overpronator, while flexible and cushioned shoes are better for people who supinate. Learn about these gait patterns and what you can do to address them if they are causing you pain (many people over- or under-pronate with no ill effects).

Pronation refers to the natural side-to-side movement of the foot as you walk or run. Your foot normally rolls a bit inward with each step.

Here is what happens during normal pronation:

• All of the toes aid in push-off, but the big toe and second toe do more of the work while the others stabilize.
• During push-off, the sole of the foot is facing the rear of your body and is not tilted so the sole is facing either inward or outward.
• From the time your heel strikes the ground, your arch begins to flatten and cushion the shock.
• If you have a neutral gait, your foot begins to roll outward with the toe-off.
• The arch rises and stiffens to provide stability as the foot rolls upward and outward.
• Your weight shifts to the outside of your foot and then back to the big toe.

The posterior tibialis muscle primarily controls pronation. It is an eccentric action in gait, not a concentric action, meaning the muscle lengthens instead of contracting.

When overpronation occurs, the ankle rolls too far downward and inward with each step. It continues to roll when the toes should be starting to push off. As a result, the big toe and second toe do all of the push-off and the foot twists more with each step.

Overpronation is seen more often in people with flat feet, although not everyone with flat feet overpronates. This gait pattern can lead to strain on the big toe and second toe and instability in the foot. The excessive rotation of the foot leads to more rotation of the tibia in the lower leg. The result is a greater incidence of shin splints (also called medial tibial stress syndrome) and knee pain.

Overpronation can also lead to excessive strain on the posterior tibialis tendon, causing shin splints and posterior tibialis tendon dysfunction in older adults. Motion-control shoes, insoles, and orthotics are designed to correct foot motion in overpronation.

Supination is a rolling motion to the outside edge of the foot during a step. The foot naturally supinates during the toe-off stage of your stride as the heel first lifts off the ground, providing leverage to help roll off the toes.

However, with supination, the foot does not pronate enough at the toe-off stage. This results in all of the work being done by the outer edge of the foot and smaller toes, placing extra stress on the foot. Supination is seen more often in people with high, rigid arches that don't flatten enough during a stride.

Supination can be associated with running injuries such as ankle injury, iliotibial band syndrome, Achilles tendonitis, and plantar fasciitis. Shoes that are well-cushioned and flexible are best for people who supinate.

Determining whether you are an overpronator, supinator, or have a neutral gait is the key to selecting the right running or walking shoes. You can do a little self-diagnosis looking at your shoe wear pattern, then get assessed at a good-quality running shoe store or foot and ankle store.

• Foot analysis: You can get a foot analysis at a specialty foot and ankle store or at some running shoe stores. They may use a foot pressure scan as well as other methods to get a full picture of your gait pattern and where you place stress on your foot.
• Have an athletic shoe expert watch you walk or run: The salespeople at specialty running shoe stores are trained to spot your gait pattern. Bring a worn pair of shoes with you so the staff person can see the shoe wear pattern. They may watch you walk or run to do a video gait analysis.
• Podiatrist: If you have ongoing foot or ankle pain, numbness, tingling, loss of function, or an injury, you should see a podiatrist. This medical professional can fully diagnose your foot health problems and prescribe custom orthotics, medication, and other therapies to correct them.
• Shoe tilt: Take a pair of shoes or boots you have been wearing regularly for several months. Put them on a table with the heels facing you. If the heels tilt inward due to more wear on the inner side of the heel, you may be an overpronator. If the heels tilt outward, you may be a supinator.
• Shoe wear pattern: Look at the soles of your current walking or running shoes. Overpronators will see more wear on the inner side of the heel and forefoot. Supinators will see more wear on the outside edge of the shoe.

If you have mild to moderate overpronation or supination and experience pain while running or walking, you can select the right kind of shoes for your gait for improved comfort. If you still have pain, you may need prescription orthotics from a podiatrist.

Overpronation

• Mild: Stability shoes

• Pronounced: Motion control shoes

• Severe: Custom orthotics

Supination

• Mild to Pronounced: Neutral, flexible shoes; cushioned shoes

• Severe: Custom orthotics

Overpronators may benefit from motion control shoes to help correct their gait. Motion-control shoes have increased medial support and stiffer construction to guide the foot into a proper amount of pronation. They are heavier and stiffer than most neutral athletic shoes.

While it has been common practice for many years to steer overpronators to motion control shoes, the research into whether these shoes prevent injury is mixed and there are few well-controlled trials, according to a Cochrane Review published in 2011.

For example, military recruits have been given motion control shoes if they overpronate, yet the rate of injury in basic combat training remained the same as when all recruits trained in military boots. You may see a debate about the value of motion control shoes for recreational runners and fitness walkers.

Custom orthotics can provide motion control for those who have severe overpronation. These are prescribed by a podiatrist and individually designed to meet the specific need of each foot.

While they can be expensive, custom orthotics may offer you relief if you have developed foot or leg pain. In the long run, this is money well spent if it means you can walk and run pain-free.

Supinators do well with neutral shoes and should look for well-cushioned shoes that can absorb more of the impact of each stride. If you supinate, you do not need motion control shoes or stability shoes.

Instead, flexible shoes will allow you a better range of motion and you may benefit from shoes or insoles that have more cushioning. If you have a severe supination problem, you can see a podiatrist for custom orthotics.

In addition to buying the right shoes, there are also a few exercises you can do to help with overpronation or supination.

If you overpronate, try these exercises while sitting in a chair:

• Arch lifts: With your foot on the ground, lift the arch without lifting your toes. Hold for three seconds, release, and repeat.
• Foot rolls: Place a tennis ball under where your big toe meets the foot. Lean forward to put weight on the ball while slowly rolling it toward your heel. Flex and point your toes to intensify the pressure.
• Towel curls: Place a towel under your foot. Without moving your heel, pull the towel toward you.
• Marble pickups: Place 10 to 15 marbles on the floor in front of you, using your toes to pick them up one at a time.
• Big toe stretch: Place your right ankle on your left knee. Grab your big toe and slowly pull it back. Hold for 15 seconds and release. Repeat on the other side.

If you supinate, exercises designed to stretch the leg muscles can help by improving ankle range of motion. Here are a few to consider:

• Calf rolls: Place a foam roller under your calf and roll back and forth for 30 to 60 seconds.
• Ankle flexion: Flex and release your ankles, or make small circles, for a few minutes per day.
• Foot pulls: Place a resistance band around the ball of your foot and pull back lightly.
• Calf raises: While standing, do 10 to 15 calf raises. You can also do these on a stair or step.
• Forward bends: While seated or standing, bend forward at the waist. This exercise helps stretch tight hamstrings.

Walking and running are great activities to build fitness and reduce health risks. Getting properly fitted for athletic shoes will help you achieve the best speed, endurance, and comfort. If you have any pain that keeps you from enjoying walking or running fully, see a healthcare provider to find the best solution.