Most people will be familiar with the terms ‘pronator’ (foot rolling in) and ‘supinator’ (foot rolling out) and may have been told in the past that this is the cause of their foot pain. Or, that if they are a pronator, for example, that they should use orthotics or foot support to prevent injury in the future. But is this actually accurate? This blog is going to look at some of the reasoning why this may not be the case.
First of all, there is a lot of confusion around the terms pronator and supinator. Does a pronator mean that you are standing in a pronated position, or does this mean that your foot moves through more pronation when you are walking? As for the dynamic movement of pronation, if someone moves through pronation in movement and they go back to neutral afterwards, they must be supinating just as much as they are pronating, so why do we call them a pronator? There is no clear definition of this term, and unless we know what a normal amount of pronation is (which we don’t), we can’t say when someone is pronating ‘too much’. These labels can often even contribute to worry, anxiety, and fear of movement, and none of those are helpful when trying to recover from an injury.
Secondly, there is not a lot of evidence to suggest that static or dynamic foot posture, a.k.a. being a pronator or a supinator (or whatever that means), predicts injury. When looking at the evidence, there are a lot of conflicting research papers. Recently, a large meta-analysis was conducted, analysing all the research papers that had studied the link between static foot posture and lower limb injury. And the conclusion of this meta-analysis was that for the vast majority of lower limb injuries, foot posture had nothing to do with it. The same research group also conducted a meta-analysis looking at dynamic foot posture and injury, even though a limited amount of evidence (meaning there was no clear consensus on this) suggested there might be a link between dynamic foot posture and certain lower limb injuries, they were unsure whether we can even clinically measure this in practice, and it certainly did not mean that every patient with a certain dynamic foot posture developed this same pain.
And even if we could measure it, do we even need to worry about it? Most people would have had that movement pattern for most of their life, and it had been fine the entire time except when they started running 3x a week after not doing any running for months. There might be other factors that are more important to identify, such as a recent change in volume of running, or poor recovery for example.
So, should we never look at the foot anymore at all when assessing a lower limb injury? Not necessarily. Although certain terms and labels aren’t helpful and don’t predict injury, we do know that in certain injuries, orthotics can be helpful to offload the injured tissue. But how does this work if foot posture doesn’t predict pain? Read more about it in the next blog post!