A new study published in the British Journal of Sports Medicine by researchers from Aarhus University in Denmark found that foot pronation may not be associated with an increased risk of sustaining a running injury.
For runners of all levels, avoiding injury is key to being able to continue running. Pronation – or how your foot rolls inward as you land – is often cited as a major concern, with too little or too much pronation potentially resulting in injury.
Specialty running shoes are designed to correct foot posture and prevent pronation injuries, but recent research suggests that simply wearing an ordinary running shoe may be enough.
Researchers chose 927 novice runners, both male and female, between the ages of 18 and 65 to ensure that the runners had no previous injuries that might affect the outcome of the study. The average age of participants was 37.
“Altering pronation with a specific type of running shoe is probably misguided.”
Each participant’s foot posture was assessed for pronation, and they were divided into five groups: supinated, pronated, highly supinated, highly pronated and neutral. Supination means that the foot and ankle tend to roll outward, while pronation means the foot and ankle roll inward.
Pronation is normal and desirable during running. When your foot pronates, or flattens and rolls inward as you strike the ground, it absorbs some of the shock from the impact of landing. Prior to this study, it has long been believed that pronating too much or too little leads to a heightened risk of injuries to the leg or hip.
Of the study participants, 369 had supinated feet, 53 had highly supinated feet (45.5% supinated), 122 had pronated feet, and 18 had highly pronated feet (15.1% pronated). The remaining runners had a neutral foot position (39.4% neutral).
All runners were then given identical lightweight, neutral running shoes and a GPS watch to record their mileage. They were instructed to report any injuries resulting from running so that medical staff could evaluate the injuries.
Participants were allowed to run at their own pace and as often as they wished, and over a one year period, they collectively covered over 203,000 miles. In total, 252 participants were injured while running; 63 of these injuries were caused by bilateral issues (problems with body alignment).
Between each of the groups, researchers found no significant difference in the chance of getting injured, a result contrary to conventional running wisdom.
In runners with neutral feet, 17.4% were injured. Injury rates among supinated runners, highly supinated runners, and highly pronated runners were higher at 17.9%, 24.5%, and 33.3% respectively.
Among those who covered at least 600 miles during the year, pronated runners had fewer injuries than runners with neutral feet; only about 13% of pronated runners were injured.
“Pronators had a significantly lower [number] of injuries per 1,000/km of running than neutrals,” the researchers concluded.
“The results contradict the widespread belief that foot pronation is associated with an increased risk of running-related injury.”
The Bottom Line
Based on this study, what seems to matter most in injury prevention is to pick a running shoe most comfortable for your feet.
If you’re looking for additional cushioning, pulling out the insole and replacing with a better quality shock absorber like a Sorbothane insert is a great way to add comfort and support.
Also gaining in popularity are “barefoot” running shoes like the Vibram Five Fingers line. These “barefoot shoes” simulate running barefoot, and with no drop from heel to toe, they encourage a more natural midfoot or forefoot strike. The soles, however, provide only a bare minimum of protection with only about 3-4mm of material between your feet and the ground, and no cushion in the heels. Individuals with high arches tend to favor these shoes, and those who prefer more arch support may not find them comfortable.
If you’re running during the summer, try to go early or late to avoid the heat, and be sure to drink plenty of fluids – especially water. Unless you’re running more than six or eight miles, you don’t need to replenish with caloric or gimmicky drinks. However, you may want to try coconut water, which is low in calories and high in potassium – a crucial mineral and electrolyte that helps runners stay hydrated and aids in recovery.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.