Sat. Jul 13th, 2024

Supination or underpronation of the feet can cause serious damage and discomfort to the entire body. If you are having trouble with your feet, legs, hips or back, it might stem from the way you walk. Learn here what supination is, how to treat it, and how to prevent it from occurring in the future.

What is supination, and what are the causes?

As a medical condition, supination of the feet, also called underpronation, is an unnatural movement occurring in our gait cycle. When we supinate, we put the weight on the outer edges of your feet when we walk, as opposed to the ball of your foot and the big toe.

Both supination and pronation are normally natural movements of our feet or arms, and describe the rotation of either.

  • When supinating, the hands are facing up (like when washing our face).
  • When we are pronating, the hands are facing down (like when typing on a keyboard).
  • Applied to the feet, they describe the rotation from the inner (supination) or outer (pronation) edges pointing towards the floor.

As opposed to the anatomical term of motion, as a medical condition supination describes a wrong posture when walking, where there is not enough of an inward roll of our feet when hitting the ground.

As a result, the weight is not properly distributed between all toes and does not reach the big toe at all. Instead, the smaller toes, which aren’t equipped to handle this force, are stressed repeatedly, leading to problems in the entire body.

Supination can be caused by several factors, like:

  • injuries
  • malformation
  • misalignment of the body
  • one-sided use & build-up of muscle mass
  • improper shoes

If a person has a malformation from birth or caused by an injury, they can adapt a relieving posture to avoid pain and cause lopsided build-up of muscle mass. People who are prone to supination but fail to use the proper running shoes for supination can worsen the issue over time.

As a result, physiotherapy is required to train the relevant muscles and fight against the misalignment of the body and feet. In some cases, the use of medication or surgeries become necessary.

What are the symptoms of supination?

There are several issues that come with supination. Since the body is a complex system, and the feet carry our weight, improper gait cycles can spread tension and pain throughout our entire body. Excessive supination can cause:

  • ankle, knee, hip & back pain
  • plantar fasciitis (inflammation of the sole)
  • frequent ankle injuries
  • stress on the knee & knee injuries

How can you tell if you’re supinating?

Tension and discomfort in the back, hips, knees, calves, and feet can be signs of a wrong gait cycle.

  • If you have problems like these, your shoes might give you a first hint at the problem. If the soles of your running shoes, for example, wear out faster at the outer sides of the shoe, you are applying too much pressure in these areas.
  • Stepping on a piece of cardboard or stepping on any surface with wet feet can point towards supination as well, when the imprint you leave does not reach your big toes or is very faint at the inner edges.
  • To diagnose the supination, a gait analysis in a specialist store for running supplies, a podiatrist’s or physical therapist’s office will help determine the cause of the symptoms.

How to correct supination

When supination is diagnosed, much of the treatment aims at correcting the incorrect posture of the feet. When the supination has already caused pain and damage to our body, anti-inflammatory medication as well as painkillers can be used. Surgery is rarely used to treat supination.

During physiotherapy, the physical therapist will teach the person exercises to strengthen the underused muscles in their legs and feet and help loosen tight tendons. They will also prescribe orthotic insoles to correct the misalignment.

Supination prevention tips

The best prevention for supination and the problems it causes can be done by wearing the right shoes. They include:

  • lightweight shoes with cushioning & room for the toes
  • (running) shoes designed for supination
  • shoes with store-bought or custom-made insoles designed for supination

Additionally, light stretches and exercise can help you develop muscles to correct the wrong gait cycle and relieve tension.


When we supinate, our feet lack a proper inwards roll when hitting the ground during our gait cycle. This way, the outer edges and small toes are impacted instead of the big toe. Since they are not equipped to handle this pressure regularly, this misalignment can cause physical pain and discomfort in many body parts. 

When you often injure your ankles or have pain in your ankles, knees, hips or back, supination can be the cause. A gait analysis or wet footprints as well as the wear of your shoe soles can let you know if your gait cycle is wrong. Shoes designed for supination, orthotic insoles, and exercises for correcting the misalignment help treat and prevent supination and its symptoms.

By Manali