Foot Pronation and Supination

This subject came up in a conversation with a client so I wanted to do some research and this is what I found. BTW, I’m a big supinator!  

Supination and pronation in the foot are terms used to describe the mechanics of how you stand, walk, and run. Ideally, your weight should be balanced on your feet as you move. Your feet shouldn’t lean in (pronation) or out (supination). In a proper stride, your foot should roll forward from heel to toe.

As you walk or run, your feet “roll” from side to side a bit with each stride. This movement is called pronation, and there is an optimal degree of it. If you overpronate or underpronate (also called supination), these mechanical problems can, over time, cause injuries. And, because the feet are the foundation that supports your body when you are upright, overpronation and supination can have a ripple effect, causing issues in your knees, hips, and back.

Pronation vs Supination


Overpronation is when the arch of the foot collapses excessively downward. This causes the foot to roll too far toward your centerline. Overpronation can result in a number of injuries including:

  • Iliotibial (IT) band syndrome (inflammation of a ligament on the outside of the knee)
  • Stress fractures in the foot or lower leg
  • Shin splints
  • Heel pain
  • Achilles tendonitis
  • Bunions
  • Plantar fasciitis
  • Chronic lower back pain
  • Patellofemoral pain syndrome

Pronation causes include flat, flexible feet with little or no arch. Pregnancy, obesity and regularly running long distances can also cause or intensify overpronation. Signs that you overpronate include:

  • No clear space between your foot and the floor where your arch should be
  • For runners, more tread wear on the inner part of your shoes
  • Footprints that show a connection between your heel and toes that is the full width of your foot (this should be about half the width of your foot)

Treatment for overpronation may include wearing more supportive shoes, wearing orthotics, and doing exercises to strengthen your arches and the surrounding muscles.


Supination (or under pronation) is when your weight rolls onto the outer edges of your feet rather than slightly inward as it should. This results in you pushing off with your smaller toes at the end of your stride rather than with the ball of your foot and big toe.  Excessive supination can cause:

  • Ankle injuries
  • Knee stress and pain
  • Back and hip pain
  • Plantar fasciitis

Supination causes include having an inherited problem with your foot structure. It can also be caused by weak muscles in your foot, ankle, or leg that result from wearing tight, rigid shoes, or prior damage to the tendons or muscles of the foot. Indicators that you supinate include:

  • Shoe wear that is focused on the outer edges
  • Little or no arch visible when you make a footprint
  • Frequent ankle sprains

People don’t realize the importance of correct biomechanical function and the many effects that improper biomechanics can have on the entire body. Some people are able to compensate for these issues and remain completely asymptomatic, however many patients have foot, knee, hip, and back issues which are actually perpetuated by poor foot function and they never know it. The importance of a thorough foot and ankle biomechanical evaluation can make a profound impact on a patient’s life.


Treatment for supination includes wearing lightweight everyday shoes with plenty of room for your toes, wearing running shoes designed for supinators, and using orthotic insoles to correct under pronation. Analyzing and improving your foot strike can have a positive impact on your body.



Massage for Foot Pronation and Supination

What is the most beneficial effect of foot massage?
A good foot massage can relieve tension and stiffness and promote better circulation and flexibility in the feet, preventing foot-related ailments such as plantar fasciitis, flat feet, and bunions.
What are the 3 benefits of foot massage?
They support us wherever we go, and to keep them strong and flexible, regular foot massage should be part of your routine.

We all know how relaxing a good foot massage can be, particularly when you’ve been on your feet all day. Our feet are hard workers and deserve to be pampered – so why don’t we massage our feet more often?

The reality is our feet are doing the bulk of our body’s work. They support us wherever we go, and to keep them strong and flexible, regular foot massage should be part of your routine.










Foot massage has been practiced in many cultures for centuries as a way to promote health and well-being. Today, foot massage is used by millions around the globe as a form of complementary and alternative medicine. Yet many people don’t realize the mass of benefits a foot massage delivers.

Many of your internal organs’ sensory nerves are in your feet. Through massage, a skilled practitioner can use your foot as a kind of detailed body map and can help treat health ailments by applying pressure on the meridian points that correspond to specific organs. This pressure effectively sends energy to weakened or troubled areas of the body, promoting both physical and psychological health.

Receiving a foot massage can:


In a study conducted by Brighton University, patients that received foot massages after receiving a coronary artery bypass graft surgery experienced higher levels of calm and feelings of psychological well-being than those who didn’t receive massages. This shows that foot massage can be an effective tool to not only decrease post-operative stress and anxiety but to promote relaxation in your daily life.


According to Harvard Medical School, foot massage stimulates your muscles, improves circulation, lessens stiffness and tension, and can eliminate pain. It also gives you a chance to properly check out your feet so you can get a headstart on treating blisters, bunions, corns, and toenail problems.


Heel pain is a common symptom that has many different causes. While many of these causes are the result of improper shoe wear, massage to the plantar fascia area can offer immediate relief. Plantar fasciitis – a painful inflammation of the fibrous band of tissue on the sole of the foot that helps to support the arch – can commonly cause pain when overloaded or stretched. People with flat feet in particular will benefit from a good foot rub.


Circulation is often impaired by tight and uncomfortable shoes, but even in the right shoes, a sedentary lifestyle may mean muscles are going for long periods of time without being used. Massaging your feet for 10-20 minutes can greatly improve circulation in the lower extremities, which is particularly important for people suffering from diabetes.


A study was conducted by the University of Canberra to learn if foot massage could be used as a healing tool for patients hospitalized with cancer. The results of the study showed that those who received foot massages for four-minute increments per foot experienced an instant improvement in their nausea and pain.


When massage is combined with foot and ankle strengthening exercises it can not only speed up the recovery of existing injuries but can help prevent future injuries also. A short massage of the feet can help ensure you minimize your risk of injury by creating stronger, more flexible feet.


Applying pressure in certain areas of the feet can relieve tension, stress, and anxiety. This system is based on the theory that there are specific places called “reflex points” on the feet, hands, and other areas that are linked to restoring the proper functioning of the body. As proper relaxation is a crucial part of anxiety and stress relief, regular foot massages are thought to aid those suffering from depression.


A study conducted on healthcare staff working with elderly people suffering from dementia – a job that is highly stressful and both physically and mentally taxing – showed that a 10-minute foot massage session up to three times a week resulted in improved mood, less anxiety, and lower blood pressure.


Foot massage just before you go to bed can help you sleep better by improving blood circulation, relaxing the nerves, and allowing the body to unwind. Restful sleep is encouraged from as little as four minutes on each foot.

Massage therapy can ease chronic heel pain caused by plantar fasciitis and plantar fasciosis but first, it’s essential that you understand how both conditions differ. Why is this important? Because plantar fasciitis and plantar fasciosis call for the exact opposite approach to massage therapy.

Adding Clarity

Both conditions involve the plantar fascia, the thick ligament that runs across the bottom of your foot and connects your heel bone to your toes. This band of tissue supports the arch of your foot and acts as a shock absorber. When the plantar fascia experiences repetitive tension and stress, it can suffer small tears and become painfully irritated.

Podiatrists use the umbrella term plantar fasciopathy when referring to plantar fascia-related conditions in general. Plantar fasciopathy is common, affecting 1 in 10 people during their lifetime. Fortunately, nonsurgical treatments, including massage therapy, are shown to resolve 90 percent of all cases within 12 months.1, 2

Plantar fasciopathy is described as an overuse or repetitive strain injury, like carpal tunnel syndrome or tennis elbow.3 The root cause of the condition is varied, including high arches, flat feet, pronation, obesity, menopause, pregnancy, middle age, older age, shoes lacking support, tight Achilles tendon, tight calf muscles, foot trauma and standing, running, hiking or walking for long periods of time.4

Plantar fasciitis and plantar fasciosis fall under the plantar fasciopathy umbrella, with both conditions characterized by a stabbing pain near the heel and usually most painful with the morning’s first few steps or after extended inactivity. But that’s where the similarity between the two conditions ends.

Plantar fasciitis involves chronic inflammation of the plantar fascia. Remember those small tears from repetitive tension and stress discussed earlier? The body’s natural response to these injuries—as with most injuries—is inflammation, which triggers plantar fascia stiffness and heel pain.

Plantar fasciosis is a somewhat recently identified condition, first described in 20035 and previously lumped together with plantar fasciitis. Plantar fasciosis is a noninflammatory degeneration of the plantar fascia—but despite this striking difference, the name is still often used interchangeably with plantar fasciitis.

“Plantar fasciosis is a condition in which dysfunctions that result in plantar fasciitis symptoms are left untreated for a long time,” explains David Edwards-Smith, a licensed massage therapist in Soldotna, Alaska, and founder of Structural Assessment Algorithm Seminars. “So, one of my first questions for a client with chronic heel pain is, ‘How long has this been going on?’ If the answer is six months, we’re strongly considering plantar fasciosis. If it’s only been a few weeks, it’s probably plantar fasciitis and, therefore, directly reducible with manual therapy.”

At A Glance

Plantar fasciopathy is an umbrella term to describe overuse injuries that harm the plantar fascia and cause chronic, stabbing heel pain. There are two plantar fascia conditions—each representing a distinct phase of damage.

Plantar fasciitis is phase 1, distinguished by inflammation. The benchmark inflammation is caused by small tears in the plantar fascia due to repetitive tension and stress on the plantar fascia. Massage therapy, with a focus on stretching and strengthening techniques, is associated with improved function in plantar fasciitis clients and may reduce heel pain.2

Plantar fasciosis is phase 2, characterized as non-inflammatory. At this point, the plantar fascia has begun to degrade. This advanced stage can result if plantar fasciitis is not properly treated in a timely manner. There are no conclusive studies to prove that massage therapy can remodel the degrading ligament, although it is anecdotally reported that techniques meant to soften and shorten the plantar fascia do help. The goal is to increase the flow of nutrient-rich, oxygenated blood to the area and thus create a healthy environment to slow or stop tissue degradation.

Technique Matters

Both conditions are manageable, but with a caveat, emphasizes Doug Nelson, a licensed massage therapist in Champaign, Illinois, and founder/president of Precision NMT seminars. “As massage therapists, we have the hands-on capacity to treat the plantar fascia—but only if we understand the problem,” Nelson says. “That’s key since plantar fasciitis often involves stretching the plantar fascia, which only further irritates plantar fasciosis.”

Here’s a look at how massage therapy needs to be adjusted for these two distinct plantar fasciopathy disorders.

Plantar fasciitis calls for massage techniques that stretch the client’s foot and posterior calf muscles, particularly the soleus and gastrocnemius muscles. “Damage to the plantar fascia is minimal at this point, so massage therapy can bring very quick results,” says Garry Adkins, licensed massage therapist and massage therapy educator in Southfield, Michigan.

Historically, a combination of myofascial and deep tissue massage has been used to treat plantar fasciitis and relax painfully tight muscles back into a normal posture, explains Erin Revels, a licensed massage therapist in Clayton, North Carolina. Revels, who works beside a physical therapist and chiropractor at the Goldsboro Spine Center, cautions against treating plantar fasciitis with a primary focus on the pain source. “I’ve never had a plantar fasciitis client who didn’t have tight fascia in other areas of the leg, especially in the calf. These muscles are normally tight because they’re trying to balance out the soleus and gastrocnemius muscles, which are also too tight.”

Adkins has recently been putting an indirect, gentler spin on this traditional therapy—with strong results. “You still elongate, or stretch the area, but you gently sink into one layer at a time. I’ve had clients get off the table after one session and say their heel pain is 80 percent better. This is after they’ve had cortisone injections and physical therapy, and still no relief.”

Giving massage therapists a heads up, Adkins adds that this gentler approach is physically demanding. “It takes 30 minutes to treat just one foot. But seeing such relief on a client’s face when they realize their heel pain is better—that’s amazing.”

Plantar fasciosis often calls for a very different approach than the one typically applied to plantar fasciitis, Nelson says. “Your goal is to soften and shorten the plantar fascia to increase blood flow to the area. If you can increase the flow of nutrient-rich, oxygenated blood, you’re creating a healthy environment to slow or even stop tissue degradation. Overly aggressive treatment and stretching can potentially undermine this goal.”

Your focus, Nelson adds, needs to be on the abductor hallucis muscle, a foot muscle that participates in the abduction and flexion of the big toe. “That muscle can put pressure on the medial plantar nerve, and if that muscle is in any way restricted, blood flow to the plantar fascia is restricted—which invites degradation of the tissue.”

Edwards-Smith points to another distinct plantar fasciosis characteristic, which is time. “With fasciosis, the condition has progressed to degenerative and you need to reverse tissue damage. The tissue will remodel, and the client is not permanently impaired, but increasing circulation to the area takes time and load management. You have to go slowly and avoid grinding into that ligament. It’s trying to heal.”

To this end, the goal is to unload the tissue around the plantar fascia and make sure everything has optimal movement to encourage blood flow. “That’s where I feel a manual therapist plays an important role, although there are no studies to my knowledge that confirm a link between massage and plantar fasciosis,” Edwards-Smith says.

Toeing the (Fine) Line

The fine line between plantar fasciitis and plantar fasciosis is complicated by the fact that no gold standard tests for diagnosing either condition exist. So to help identify the problem, Edwards-Smith relies on an evidence-based assessment algorithm. “You look at the entire foot—beyond the heel—as well as the calf. Does your client’s foot move fluidly? Is there pronation? Supination? Proper plantar flexion extension? Can you identify a lack of movement between foot bones? I’m not talking about a diagnosis. This is an assessment to determine a technique relevant to the presented condition.”

As for whether or not the massage therapist chose the right technique, there’s no definitive test for that, either. “Podiatrists, physical therapists, massage therapists—we all must use clinical reasoning skills to guide our approach to treatment,” Nelson explains. “If a client says they have plantar fasciitis and they’ve done everything that every health care provider asked them to do to treat inflammation but nothing helps, that’s a good indication that, in fact, inflammation is not the problem. Maybe the condition has progressed to fasciosis and as a massage therapist, I need to look at therapies that restore optimal circulation to the plantar fascia.”

Regardless of the diagnosis and appropriate therapy, plantar fasciitis and plantar fasciosis are treatable—although both can return. “I think it’s important to warn clients that the pain relief massage therapy brings isn’t permanent—not unless they figure out the original cause and find a solution,” Revels says. “That’s a discussion that needs to happen with a doctor.”

When the plantar fascia is restored to good health, the original injury’s cause is addressed and, if necessary, massage therapy sessions for maintenance are scheduled, then it’s very likely that heel pain got the boot.


Write in-depth research and the science of massage for Foot Pronation and Supination

Title: The Science of Massage for Foot Pronation and Supination: An In-depth Exploration

Abstract: Foot pronation and supination are biomechanical movements that play a crucial role in maintaining optimal gait and foot function. When these movements become imbalanced, various musculoskeletal issues can arise, impacting overall body alignment and function. Massage therapy has gained recognition as a potential intervention for addressing foot pronation and supination-related concerns. This research delves into the biomechanics of foot pronation and supination, explores their potential impact on the body, and examines the scientific basis for utilizing massage as a complementary approach to manage these issues.

1. Introduction: Foot pronation and supination are natural movements that occur during the gait cycle. Pronation involves the inward rolling of the foot, allowing for shock absorption and adaptation to uneven surfaces, while supination is characterized by the outward rolling of the foot, providing stability during the push-off phase. Anatomically, these movements are governed by the subtalar joint, composed of the talus and calcaneus bones, and are influenced by various intrinsic and extrinsic factors.

2. Biomechanics of Foot Pronation and Supination: The subtalar joint functions as a complex mobile adapter, transmitting forces between the lower leg and the ground. During pronation, the talus shifts medially and dorsiflexes, causing the foot to flatten and the arch to lower. In contrast, supination involves the lateral shift of the talus and plantarflexion, resulting in a higher arch and increased foot rigidity. The muscles and ligaments surrounding the subtalar joint play a significant role in controlling these movements.

3. Impact of Imbalanced Pronation and Supination: Irregularities in foot pronation and supination can lead to a range of issues. Overpronation, for example, can contribute to conditions like plantar fasciitis, shin splints, and patellofemoral pain syndrome, due to altered lower limb alignment and excessive stress on certain structures. Conversely, over supination may lead to problems like stress fractures, iliotibial band syndrome, and ankle sprains, as it limits the foot’s ability to absorb shock and adapt to surfaces.

4. Massage Therapy as an Intervention: Massage therapy has been recognized as a potential intervention to address foot pronation and supination-related concerns. Through various techniques, such as effleurage, petrissage, myofascial release, and trigger point therapy, massage aims to alleviate muscle imbalances, improve circulation, enhance flexibility, and promote relaxation. These effects collectively contribute to improved biomechanics and reduced stress on the affected structures.

5. Scientific Basis for Massage Efficacy: Several scientific mechanisms support the efficacy of massage in managing foot pronation and supination issues. Massage increases blood flow, which can aid in the delivery of nutrients and the removal of waste products from muscles and connective tissues. Moreover, massage promotes the release of endorphins and reduces cortisol levels, contributing to pain relief and relaxation. Myofascial release techniques target fascial restrictions, potentially improving the balance between muscles and enhancing joint mobility.

6. Clinical Studies and Evidence: While limited research specifically focuses on massage for foot pronation and supination, studies related to massage for plantar fasciitis and ankle injuries indirectly provide insights. Clinical trials evaluating the effects of massage on pain, flexibility, and function have shown promising results. However, more research is needed to establish a direct link between massage and the correction of foot pronation and supination imbalances.

7. Considerations and Future Directions: When implementing massage therapy for foot pronation and supination concerns, individualized approaches are crucial. Collaboration between massage therapists, physiotherapists, and orthopedic specialists can lead to comprehensive treatment plans tailored to each patient’s needs. Future research should aim to fill the existing gaps in knowledge, exploring the specific effects of massage on subtalar joint mechanics and its long-term impact on foot function.

8. Conclusion: Foot pronation and supination are integral to efficient gait mechanics, and imbalances in these movements can lead to various musculoskeletal issues. Massage therapy, through its multifaceted effects on muscle, fascia, and overall well-being, presents a promising avenue for addressing these concerns. As our understanding of the biomechanics and therapeutic potential of massage continues to evolve, it holds the potential to complement traditional interventions for managing foot pronation and supination-related problems.

Keywords: foot pronation, foot supination, massage therapy, biomechanics, gait mechanics, musculoskeletal issues, myofascial release, clinical studies.




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