Foot Pronation and What Problems It Can Cause

By Dr. Jackie Sutera


Pronation describes a flat foot type called pes planus. Genetics determines this in almost all cases, except for instances of injury, wear and tear or some disease processes. Abnormal gait is described as any walking pattern which inhibits walking in the usual way. The most common reasons for abnormal gait are flat feet, overpronation, or pes planus foot types. When feet are flat and balanced, the arch can touch the ground causing poor biomechanics and lower limb malalignment. This can cause a misalignment to the knees, hips, and back and an abnormal gait pattern. It’s normal to pronate throughout the gait cycle, but overpronation can cause many foot problems.


Rare and severe breakdown of the foot and “collapse of the arch” can be caused by a neuroarthropathy disease process like diabetic charcot foot. Commonly associated problems for people with flat feet include: hammertoes, calluses, corns, heel spurs, fascitis, foot/ankle/heel pain, shin splints, bunions, arthritis, bone spurs, instability, etc. can all form as a result of flat feet.  


Treatments include:


Arch support

Arch support can help set a more neutral foot, keep you from overpronating, and create a foundation for the entire skeleton. Arch support is a raised padding or elevation located on the top of insoles in shoes or incorporated into orthotics to help elevate and neutralize the inside of the midfoot. It is important because if the arch is abnormally flat or pronated, many problems can occur or be made worse, such as bunions, hammertoes, tendonitis, fasciitis, back, hip, knee pain, etc.



In more severe cases of flat arch feet, surgery can be an option to bring up the arch or correct the associated problems.



There are custom molded orthotics made at your podiatrist’s office and over-the-counter versions, like Vionic’s insoles. Vionic has several styles, including Active, Relief, and Slimfit depending on your specific needs. Flatter feet need more stability and control and often benefit from a more rigid device to hold up the arch. Flat feet, or feet that “overpronate,” need to have the excess pronation reduced to make the foot function more neutral. A thicker overall sole is best and preferable to a flat one. It’s about keeping your foot as neutral as possible and not pronated (rolling inward.)


It’s appropriate to have children with flat feet evaluated. Treatment may be needed in some cases, especially if the deformity is severe, worsening or if they are having pain. Adults with foot pain or worsening symptoms due to high or flat feet should also seek help from their podiatrist. 


What leads to a lack of natural arch support?

Wear and tear over time, obesity, pregnancy, injury, or hereditary factors can cause the natural arch to decrease over time. 


Are there any exercises to better support?

While no exercise can reform the arch, it is essential to massage it and do calf stretches. The Achilles tendons (connected to the calf) and the fascia (the major component of the plantar arch) are connected to the heel bone. The fascia also gets stretched and elongated when stretching the Achilles tendon by doing calf stretches. This reduces tightness, soreness, and inflammation. 


 About the Author:

Dr. Jacqueline Sutera is a surgically trained doctor of podiatric medicine specializing in the prevention and treatment of foot pathology. She graduated from Fordham University with a Bachelor of Science degree in Biology and Philosophy. She later attended the New York College of Podiatric Medicine where she earned the degree of Doctor of Podiatric Medicine (DPM). Dr. Sutera received her postgraduate residency training at the busy level-one trauma center at Jamaica Hospital in Queens, NY and Brookdale Hospital in Brooklyn, NY. During her time there, she served as chief surgical resident and received and completed training in all aspects of podiatric medicine and surgery. Dr. Sutera is Board Certified in Foot Surgery and is a Fellow of the American College of Foot & Ankle Surgeons. She is also a proud member and spokesperson for the American Podiatric Medical Association and the New York State Podiatric Medical Society. As one of NYC’s premier podiatric physicians, she is a caring, conscientious and extremely personable doctor who prides herself on being holistic in her approach to foot care. Where other doctors treat feet only locally, she has a unique gift of being able to link some foot problems to other underlying conditions taking place in the body.


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