What is the difference between Overpronation and Underpronation?

Overpronation or underpronation usually refers to running, but anyone who walks pronates. Pronation is related to gait and how your feet and ankles function as you walk or run. As your foot gets closer to the ground, the inside of its arch flattens out. Pronation is when your foot first makes contact with the ground. Your arch flattens to absorb the shock of your foot strike and gets your foot ready for the next phase of your stride. Ideally, your pronation should be neutral, with your foot rolling forward from heel to toe.

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Overpronation

Overpronation, also known as excess pronation, means that your foot rolls toward the inside when you walk, and your arch tends to flatten out. If you overpronate, your shoes will wear unevenly on the inside part of the sole. Excess pronation is a more common gait problem than underpronation.

In a normal stride, also referred to as a neutral stride, your foot should pronate or roll a bit inward so that your weight will rest on the ball of your foot. As your stride continues, your foot will push off on your big toe. The problem occurs when your foot rolls too much inward, causing an imbalance.

Overpronation can lead to developing pain in your:

  • Arch.
  • Heel.
  • Ankle.
  • Shin.
  • Knee.
  • Hip.
  • Back.
an illustration of overpronated feet

Image via BraceAbility

What Is Underpronation?

Underpronation is also called excess supination. If your foot supinates, it means that your weight rolls to the outer edges of your feet.  Due to this, underpronation causes you to push off from your outer toes. If you underpronate, your shoes will wear unevenly on the outer sole.

Underpronation can affect the whole alignment of your body and lead to conditions such as:

  • Plantar fasciitis, which is an inflammation of the sole.
  • Back and hip pain.
  • Excess stress on the knee.
  • Ankle injuries.

What Causes Overpronation and Underpronation?

In many cases, overpronation or underpronation is a result of the kind of feet you have. You were most likely born with feet that don't have a neutral gait or are prone to an imbalance. These variations can be due to arches that are too high or not high enough, as in flat-footedness. Gait imbalance can also be caused by having legs of uneven lengths. Other causes of gait problems can be injury, overuse, walking, or standing on hard surfaces for extended lengths of time. In the case of overpronation, obesity or pregnancy can be contributing factors.

How is Gait Pattern Diagnosed?

To determine whether you're an overpronator or an underpronator, you can start with self-diagnosis by looking at your shoes' wear pattern. Follow this up with an assessment from a specialty running shoe store or a shoe store that specializes in orthotics.

Your diagnostics may include the following:

  • Foot analysis. Available at a specialty foot and ankle and some running shoe stores. Usage of a foot pressure scan and other testing methods allows for a full assessment of your gait pattern and reveals what part of your foot endures the most stress. 
  • Expert observation. An athletic shoe expert can watch you walk or run. Running shoe stores are staffed by trained salespeople who can determine your gait pattern as they observe you in motion. They may do this by direct observation or run a video analysis. You should also bring along a pair of shoes or sneakers that you've worn for a while so that they can examine the wear pattern. 
  • Podiatrist. Seek medical care from a specialized doctor who deals with foot health if you're experiencing any ongoing foot or ankle problems, including foot or ankle pain, decrease or loss of function, numbness, tingling, or injury. A podiatrist can give you a comprehensive diagnosis and prescribe you custom orthotics, medications, or other therapies to help correct your imbalanced gait pattern. 
  • Shoe tilt test. Place a pair of your well-worn shoes, boots, or sneakers on a table, and make sure the heels are facing you. The heels will tilt inward in the case of overpronation due to increased wear on the inner side of the heel. If you observe that the heels tilt outward, it's more likely that you're an underpronator.
  • Shoe wear pattern observation. Grab a pair of your current running or walking shoes and look at the soles. If the inner side of the heel and forefoot show more wear, you're an overpronator. If your shoes have more wear on the outside edge, you're an underpronator.

What Are Some Treatment Options for an Imbalanced Gait?

Possible treatments, ranging from mild to severe, for overpronation are: 

  • Stability shoes. Designed with supportive features in the midsole to prevent overpronation.
  • Motion-control shoes. Shoes designed to limit excessive foot movement.
  • Custom orthotics. Devices designed specifically for your foot to support and comfort your feet.

Possible treatments for underpronation are: 

  • Neutral, flexible shoes. Flexibility in the sole allows your foot to flex properly.
  • Cushioned shoes. Cushioning helps absorb the force of impact.
  • Custom orthotics.

Your healthcare or shoe store professional may recommend a series of exercises based on your condition. These exercises may also be combined with physical therapy, custom or semi-custom orthotics, a change in shoes or sneakers, and medication. Rare cases may require surgery if your problem stems from a more serious condition of the foot.

While the tendency to overpronate or underpronate can pose challenges to runners, athletes, and workers who spend more time on their feet, these foot conditions can be diagnosed and effectively treated.  Treatment will enable you to continue to work in your field or compete in sports professionally or recreationally. Don't put off examination and treatment, as leaving these conditions unchecked can lead to injury, damage of your feet, ankles, and legs, and cause pain in other areas of your body.


In the Chicago area, podiatrist Dr. Scheone of Gurnee Podiatry & Sports Medicine is a sports medicine specialist and Certified Athletic Trainer, practicing sports medicine for decades. Skilled in all aspects of podiatric medicine, Dr. Schoene can diagnose and treat any foot condition, including those affecting your gait pattern. Her experience considers the kind of movements specific to each sport to provide tailored solutions based on what will work for your activities. Don't hesitate to contact us and schedule an office visit to explore how Dr. Schoene can help you.