OK, It's Offical: Pronation Does Not Cause Injury

Tell that to my shins, sciatic nerve and plantar fascia.

The first sentence says it all- NORMAL pronation.

No one EVER thought normal pronation causes injury.

Over pronation causes injury.

Now shut up.

Normal pronation is misdiagnosed as over-pronation on a daily basis at every specialty running store in the country. That's the point. True over-pronation is VERY RARE.

How_Fast? wrote:

Normal pronation is misdiagnosed as over-pronation on a daily basis at every specialty running store in the country. That's the point. True over-pronation is VERY RARE.

False.

footmender wrote:

How_Fast? wrote:

Normal pronation is misdiagnosed as over-pronation on a daily basis at every specialty running store in the country. That's the point. True over-pronation is VERY RARE.

False.

+1

The problem is trying to treat something like over-pronation with shoes or orthotics instead of addressing the issues with their gait. If an athlete lacks flexibility in certain joints, like their ankles or hips or they are weak in their feet or hips then that needs to be addressed or they will battle with injuries their whole career and no special device is going to help them.

"normal pronation"=neutral foot

Old time sprinter wrote:

The problem is trying to treat something like over-pronation with shoes or orthotics instead of addressing the issues with their gait. If an athlete lacks flexibility in certain joints, like their ankles or hips or they are weak in their feet or hips then that needs to be addressed or they will battle with injuries their whole career and no special device is going to help them.

Well said. This is the best advice I've seen on this. Appropriate footwear is important, but if you are a mess structurally, functionally, or biomechanically, identifying and addressing these issues is critical.

The title of the study says it all: "Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study."From the abstract:

The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.

This really isn't anything earth-shattering. Most scientific evidence in recent years has been indicating that pronation is not associated with injury.

The authors of this study used the foot-posture index, which is a common, scientifically-vetted, and well-accepted measurement of rearfoot mechanics. Here is the breakdown of the 1854 feet (two per runner, obviously...) in the study:

highly supinated: 53

supinated: 369

neutral: 1292

pronated: 122

highly pronated: 18

Highly pronated feet represent less than 1% of the population. As for whether "normally" pronated are misdiagnosed as "highly pronated," I can't really speak to that.

The original post is also misleading—there was NO statistical difference in ANY of the foot conditions when comparing to neutral feet (even the highly pronated feet!). Pronators as whole actually suffered significantly fewer injuries per 1000km of running than neutral runners. While the "risk difference" of highly pronated feet was indeed higher, the very small number of these kinds of feet made this difference statistically insignificant (p = 0.51 for you statisticians). You can't make any conclusions about highly pronated feet with such a small sample anyways.

Here is a brief summary of what the most recent scientific literature has to say about pronation:

1) Pronation is a normal foot motion that occurs to various degrees in different peoples' feet

2) Pronation is not significantly associated with injury rate. If anything, pronators may be slightly healthier than non-pronators

3) Pronation cannot be consistently controlled or altered by any shoe, orthotic, or other intervention.

4) Prescribing shoes based on arch type or pronation status does not result in a lower injury risk

All that being said, it is good that a wide variety of shoes exist. Best practices dictates that you should pick a shoe based on comfort—for some people, that might indeed be a stability shoe. But this idea that you "need" a stability/motion control shoe because your foot is pronated has got to go.

Great objective evaluation of the data that's out there. I have to disagree with point #3, however. Although the most recent scientific literature may have concluded this, it simply is not true. Perhaps their study was too narrow, but to conclude that ANY shoe, orthotic or other intervention could not consistently control pronation is false. Certainly, if put into an aggressive custom orthotic, the joints of your foot will not undergo as much rearfoot and midfoot pronatory excursion(simplified explanation). Also, to just prove the "ANY" part of the equation incorrect, if one were in a hard cast, brace, or had a rod driven across their rearfoot joints, these interventions would severely limit or entirely block all pronatory joint motion. I cannot think of an example of a shoe alone that would have much control over foot pronation, however.

ps. I hope you are doing well up there, NS!