Pronation and Knee Pain

What is Pronation?

Pronation refers to the way the foot deals with shock absorption when you walk or run. Although a person’s level of pronation is not a cause for concern, it does impact the way a person walks or runs which could lead to injuries and/or pain in the legs and knees. 

Pronation happens at the subtalar joint, which is the joint below the ankle. It describes the inner rolling movement of the foot just after it meets the ground. This moment is known as initial contact, which is a part of the stance stage of the gait cycle. Today, running shoes are designed specifically for different pronation patterns. When people choose their running shoes, the type of their pronation is a vital factor in their choice.

Types of pronation

Pronation can be broadly classified as:

  • Normal pronation.
  • Underpronation.
  • Overpronation.

What is normal pronation?

In the normal pronation, the external part of the heel of a person makes its first contact with the ground. The foot rolls internally about fifteen percent, and it meets the ground, and supports the body weight of the individual without any difficulty. The inward rolling of the foot optimally dispenses the impact forces. This motion is known as pronation, and it is critical to manage shock absorption.

What is Underpronation?

Underpronation is the inadequate inward roll of the foot after meeting the ground. Again, the exterior of the heel makes its first contact with the ground. However, here, the internal movement of the foot happens to be less than 15%, which means that there is less inner rolling than those, having normal pronation or flat feet. As a result, the impact forces are focused on a smaller foot area, which is the external part, and the forces are not distributed efficiently. In the push-off stage, the majority of the work is carried out by the smaller toes on the external part of the foot. This places additional stress on the foot, which can lead  to iliotibial band syndrome, plantar fasciitis and Achilles tendinitis. Underpronating will cause the external edge of running shoes to wear faster. Runners with tight Achilles tendons and high arches are inclined to be underpronators.

Ways to prevent knee pain due to underpronation

Underpronators are supposed to do additional stretching for the hamstrings, calves, iliotibial band and quads. Here are some useful tips for underpronators to assist them to find the right shoes for their feet.

  • They should wear shoes with extra cushion or insoles towards the outer portions of the shoe..
  • They should seek lightweight trainers because they allow more foot movement.
  • They should check for the flexibility on the inner edge of their shoes.
  • Wearing the correct type of running shoes and changing the worn-out ones will assist prevent knee pain, as well.

What is overpronation?

Like with the normal pronation, the exterior of the heel makes its initial contact with the ground, but here, the foot rolls internally more than the ideal 15%, meaning the ankle and the foot have problems in stabilizing the body, and the shock is not absorbed as resourcefully as in the normal pronation. At the end of the walk or run cycle, the front part of the foot leaves the ground using the big toe largely and the second toe, which then have to do all the work.

Ways to prevent knee pain due to overpronation

Overpronation results in extra tightness and stress to the muscles, so overpronators should perform extra stretching. Here are some tips for overpronators to help them locate the right shoes for their feet to avoid knee pain.

  • Overpronators should wear shoes with extra arch support.
  • They should search for motion-control or stable shoes with stiff, multi-density midsoles and outside control features that manage pronation. 
  • Too much movement of the foot can result in calluses, runner’s knee, bunions, Achilles tendinitis and plantar fasciitis.


Controlling pronation lessens probability of injury to your knees and legs. First, people should choose a shoe that offers them a comfortable fit as comfort is the first indicator of reducing the chances of other foot problems. Next, people should focus on all of the non-shoe factors, most significantly, training errors. Finally, the underlying reason for virtually all overuse knee pains is still the simplest, which is too much, too quickly.

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