What Injuries or Pain Syndromes Can Be Related to Over Supination

• Lateral Instability
• Under Pronation
• Over Supination Injuries

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  Richard Blake KRM team

  6/4/24, 10:14 AM

  Now let’s talk about contact phase over supination, and why I think it is so much worse than most cases I see of over pronation (with hundreds of exceptions). When the foot strikes the ground, the entire limb above it is internally rotating, and so must the foot for all to go well. Supination of the foot, or external talar rotation, at a time when the limb is internally rotating, will produce a strain somewhere from the foot, ankle and up the leg. Also, by eliminating one of our bodies  mechanisms for shock absorption in the motion of pronation, you now have a petri dish for stress fractures, joint arthralgias, and low back pain. Finally, contact phase supination causes,what  is sometimes called, lateral instability. Do not take this lightly! Whenever the word “instability” is used in the lower extremity, weight bearing will be affected, falls will occur at a higher rate, and our job of rehabilitation becomes more challenging. Dr. Root defined the tipping point into over supination as 3 degrees past neutral subtalar joint, and most say 3 degrees past vertical. Simply ⅛ to ¼ inch valgus wedges can help. There is no over the counter insert for supinators that I have any experience with, but some low arched inserts with a deep heel cup can be a starting point to then add a valgus wedge. 

       Here is the list I give to students about the injuries created by excessive supination, which is also called under pronation, and also called lateral instability. Someone may be an excessive supinator only when they wear certain shoes. Someone may be structured to overly supinate even barefoot (high degree plantar flexed first metatarsal for instance). Excessive supination causes injuries because of lateral instability, and/or because the lack of pronation means no shock absorption, because there is lateral weight bearing on the foot for a prolonged time, and there is excessive medial loading of the ankle and knee. Injuries can also occur since there is knee extension at contact, not the normal knee flexion. Here is a summary of the problems related to oversupination. These injuries include:

  1. Hammertoes
  2. Lateral Metatarsalgia
  3. Tailor’s Bunion
  4. 4th and/or 5th metatarsal fractures
  5. Cuboid pain
  6. Lateral Ankle Instability
  7. Peroneal Strain
  8. Haglund’s Deformity
  9. Medial Ankle Impingement
  10. Fibular Stress Fractures
  11. Proximal Tib-Fib Sprain
  12. Medial Knee Compartment
  13. Knee Arthralgias
  14. Lateral Collateral Ligament Sprain (Knee)
  15. Lateral Hamstring Strain
  16. Iliotibial Band Syndrome
  17. Femoral Stress Fractures
  18. Hip Arthralgias
  19. Sacroiliac Inflammation
  20. Low Back Pain

   

  

  Soft Hannaford style Orthosis with additional Medial (varus) and Lateral (valgus) wedging

   

  

  Supination during the contact phase of gait is abnormal

   

   

  

  Simple image of abnormal supination causing lateral instability and possible ankle sprain

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