Overpronation and Knee Pain: Causes and Prevention

Are you an overpronator? Do you suffer knee pain? Discover the relation between overpronation and knee pain.


The feet are essential for proper running form and good biomechanics, but they are often neglected by runners.

Trying to run with poor foot mechanics is like trying to build a house on unstable foundations: it’ll lead to big problems further down the line.

Many runners’ careers have been cut short by ignoring their body’s biomechanics, so it’s essential for any runner to learn about pronation and what can be done to help if it’s causing a problem.

Runners typically fall into one of three categories:

  • Overpronators.
  • Neutral.
  • Underpronators.
overpronation knee pain

Overpronators have an ankle that rolls inwards when they’re running, sometimes because of flat feet, while underpronators have an ankle which doesn’t roll in enough.


¿Can overpronation cause knee pain?

Overpronation, where the ankle rolls inwards while running, is often harmless, but it can also cause pain and injuries throughout the body’s kinetic chain.

The problem occurs when the overpronation of the ankle joint causes the lower leg to rotate inwards, which then places extra forces on the knee.

This article will go through the science behind overpronation and knee pain, as well as what a runner can do about it.

Basically, if your foot arch overpronates then it can cause pain in the foot, shins, knee, hip and even the lower back, simply because the leg isn’t aligned correctly.

So what actually happens when a person runs on a foot that overpronates?

When the foot first hits the floor, the ankle and foot rolls inwards.

To a certain extent this is normal, but when it happens excessively it causes the lower leg to also rotate inwards.

This affects the alignment of the knee, so it sometimes doesn’t track in the patella-femoral groove correctly.

The result is extra rubbing and strain on the knee joint, which results in pain. When this happens, the upper leg is affected and the hip becomes mis-aligned.

Finally, this can then cause the lower back to twist, completing an entire chain of problems.

This is why the lower body is often said to be connected via a “kinetic chain”: if there is a problem with one part of the chain then it can affect the others.

Finding out whether you overpronate is actually relatively straightforward process.


Although a professional podiatrist will be required to assess whether pronation is the cause of any problems.

Simply wet the bottom of your feet and stand where water will show up clearly: a kitchen floor can be good for this.

If your footprint is almost the same width along its entire length then you probably have a pronation problem.

With that said, many people run for years with overpronation issues without any injuries.

There are nearly always other contributing factors to overuse injuries, but poor foot biomechanics can make a big difference.

As a general rule, the more excessive the pronation the more likely it is that problems will occur.


If overpronation is caused by a structural issue then it is difficult to solve.

Instead, it is important to prevent the foot from rolling inwards too much during running, so either supportive shoes or orthotics are used.

Mild overpronators should use supportive shoes, while excessive overpronation will be better served by motion control shoes.

If overpronation is causing pain, then custom made orthotics may be required.

There are a number of shoes which are built specifically for runners who overpronate.

The Asics Gel Kayano, for example, is one of the most popular, and provides a high level of support for the foot arch.

It’s important to remember that these shoes aren’t made for everyone.

If your foot arch underpronates, then a motion control shoe can contribute to additional problems.

For this reason it’s nearly always a good idea to get a pair of running shoes fitted by a professional so you know you’ve bought the right pair.

Orthotics provide more control and support for people who overpronate, but are also much more expensive.

To get a pair of orthotics professionally fitted can cost hundreds of dollars, but nothing else will provide the same custom fit and level of support.

If you’re having problems with your knees, shins or hips, then a visit to a podiatrist who specializes in running injuries may be a good idea.

How to fix Overpronation

Learn how to identify the root causes of ankle overpronation and what you can do to fix this issue.

Check out this video to learn the 3 most common causes that lead to pronated feet and then watch the next video to learn how to properly address these three things and fix overpronation for good.

If you’ve been told that your feet over-pronate or that you have flat arches, these exercises may be for you. You have to strengthen both the intrinsic foot muscles (small muscles inside the foot) as well as the ones that control pronations (tibialis posterior and tibialis anterior muscles).

Overpronation and running

In contrast to supination, overpronation results in a strong inward buckling, which places greater stress on the entire foot and joint apparatus.

The angle is approx. 4-15°. This means that the natural stability of the foot is no longer sufficient. This results in a twisting of the lower leg bones, and the layer of cartilage located behind the kneecap becomes more susceptible to injury due to this movement in the knee joint.

Runners can easily recognize overpronation by the worn out insides of the sole on older, worn-out running shoes. Overpronation is promoted by old or incorrect running shoes.

To mitigate or completely avoid the negative consequences of overpronation, runners should wear insoles in their running shoes or wear running shoes with special pronation supports on the inside.

The pronation support gives the foot additional support and thus counteract the overpronation. Often, a combination of insoles and stable shoes is also advisable when stable running shoes are no longer sufficient. This helps in particular to prevent typical sports injuries, such as Achilles tendon problems or runner’s knee.

Nevertheless, the goal should be to minimize the supportive effect of the running shoes and insoles, without making them too little, to prevent the complaints.

Here is the often difficulty to find the right decision and choice. Here, the development of the runner should also be taken into account, which can be documented especially by old running shoes.

The current running shoe models also offer a finer tuning of the pronation supports than was the case a few years ago, so that the individual needs of the runner can be addressed more precisely. In the case of low pronation, even neutral running shoes can provide sufficient stability nowadays. Over time, running shoes have been optimized so that they already reduce the leverage forces of pronation.

Overpronation describes an increased inward buckling of the foot and thus increases the risk of injury. In the case of overpronation, both insoles and pronation supports can provide relief.

Does Pronation Matter When you buy running shoes

You know the drill.

The shoe salesman watches how you stand, barefoot or in shoes.

Next you walk back and forth, jog in place, maybe on a treadmill. Barefoot and maybe in your current shoes.

This ritual has been drilled into peoples’ heads for decades, yet, it may not matter. Or more appropriately, it may matter in that it does not really matter.

A few studies in the last few years have looked at how shoes prescribed based on a person’s foot affects injury rates, and results have been quite interesting.

The first study took 81 women categorized as either neutral, pronated, or highly pronated. Next they were randomly given a pair of neutral, stability, or motion control shoes. They then began a 13 week half marathon training program.

Over the course of 13 weeks, 194 missed training days were reported by 32% of the athletes. Those in motion control shoes reported the majority of these days. All of the “highly pronated” individuals in the motion control shoes reported pain. In pronated feet, the stability shoe wearers reported more pain than those in neutral shoes.

Simply put, “The findings of this study suggest that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.”

Next, a Danish study observed over 900 novice runners for one year, categorizing them into the various foot-types. They were all given a neutral running shoe, regardless of their foot type.

252 of the runners reported an injury that restricted running for at least 1 week. Over the year, there were no observed differences in injury rate among the various foot types, even though they were all in the same shoe.

One of the authors told Runner’s World Newswire, “Based on our findings, healthy new runners with pronating feet face the same injury risk as their neutral peers when taking up running in a neutral shoe. It seems like a neutral shoe is a feasible choice regardless of the foot posture. New runners may focus on comfort feeling rather than foot posture when choosing a running shoe.”

Another study of 25,000 footsteps by Robin Huw Crompton led him to conclude that “”A sports shoe with a lot of arch support might not be such a great idea,” he says. A bit of cushioning is fine. “But I’d look for a shoe that lets your toes wiggle and doesn’t constrain foot motion. You want your foot to be able to move and flatten because that’s what it’s designed to do.””

So, if basing your footwear choice on how your foot moves and is shaped does not really matter…what does matter?!?

Comfort – When people ask, “which bike should I get”, the best answer is the one they are most comfortable on and fits the best. Same with shoes. Regardless of what research or anyone says, you will be healthiest and fastest when comfortable.

Strength – Frequent and consistent ancillary work to both prevent and heal injury is incredibly important. If you are not doing this on a regular basis, you’re doing your body a disservice.

Mobility – This is a combination of soft tissue work such as foam rolling, stretching, and joint mobilization.

But, some people may pronate a bit more than what may be optimal. What are they to do?

We’d suggest to address the issue at its source, which is potentially a lack of muscle strength or a slight imbalance. Weak posterior or anterior tibialis or peroneus longus may contribute to over-pronation.

Overpronation and Knee Pain