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Why do my shoes wear on the outside? [Over Supination] & what you can do about it

Over Supination

Ever wondered what this means for your body position and your risk of injury? Over Supination can cause pain in the outside of the foot on impact (e.g. running) and be linked with other injuries

I see this all the time with patients and it’s worth looking out for… WHY? 

over supination
Over Supination - Gif Courtesy Of Asics

The Mechanics of Over Supination

Excessive wear on the outside of your shoes is a sign that your pelvis is in the wrong position and you aren’t able to shift freely between the left and right hip, during normal walking or running.

The wear on your shoe means the foot and ankle is held in a turned out (over supinated) position and you are unable to roll (pronate) the foot on to the arch, which is needed for normal walking and running mechanics.

The ability to feel or ‘sense’ the arch of your foot during walking and ‘push off’ the big toe is essential for a normal walking pattern.

The right arch as it comes in to contact with the ground (or your trainer/orthotic) is the ‘switch’ to allow the right foot to turnout (re-supinate) and fire up the right glute muscle.

By shortening, the right glute pushes the pelvis forward and across to the left (in an anti-clockwise direction). Without the ‘switch’ from the arch, the pelvis can be held in an abnormal pattern and is unable to move correctly. The image of the worn school shoe above is that from a talented young tennis player. It's a good example of someone who is walking and playing sport in the wrong position, which led to attending my clinic with a 'pinching' hip pain.

The right arch as it comes in to contact with the ground (or your trainer/orthotic) is the ‘switch’ to allow the right foot to turnout (re-supinate) and fire up the right glute muscle.

I already have orthotics so why is this happening?

One of my biggest bugbears is the use of orthotics (appliances in footwear) to try and improve overuse injuries and foot stability.

Most patients I see with recurrent chronic ‘overuse’ injuries such as plantar fasciitis, achilles tendinopathy, patella tendinopathy and recurrent trochanteric hip bursitis have had orthotics made to try and rectify the injury.

The theory behind traditional orthotics (see blue pair of orthotics in image below) is to prevent ‘over-pronation’ and reduce the pressure on the inflamed area. In reality, the orthotics often actually prevent ‘normal pronation’, which is needed for ‘normal’ movement, and they force you onto the outside of the foot.

As a result, a body already in a poor position for movement (indicated by the presence of an injury or pain), now develops an additional ‘compensation’.

The orthotics are often too firm and rigid which doesn’t allow the foot to move freely. In addition, the heel cup on the orthotic is not deep enough to hold the heel bone in a stable position.

I frequently remove orthotics from patients in the clinic. If the orthotics are moulded so that you sense the weight on the outside of the foot, this indicates you are being ‘held’ in a dysfunctional pattern. In our clinic we use PRI orthotics which are moulded ONLY when the pelvis and foot are in the correct position - so they keep you there. They hold the heel in a stable position and will enable 'normal pronation'.

over supination orthotic
PRI Orthotics Compared to Traditional Orthotics

Being held in a strong pattern at the foot will influence the body higher up at the pelvis (hips) and whilst the initial injury or pain may be resolved, you may then develop injury in a different area of the body.

Can this increase my risk of injury and pain?

If you sense more weight on one heel bone compared to the other this is another indication that you don’t have normal pelvis positioning and walking (gait) mechanics. You will likely not feel balanced and grounded on both feet.

Being held in a strong pattern at the foot will influence mechanics higher up at the pelvis (hips) and whilst the initial injury or pain may be resolved, you may then develop injury in a different area of the body.

As you’d expect, people who are walking, running and playing sport on the outside of their feet (feet are in a turned out/supinated position) often comes hand in hand with outward movement at the hips.

This leads to the deep hip muscles becoming short, tight and overactive and cause the thigh bone (femur) to glide forward. This prevents the thigh bone (femur) from being seated in the correct position deep within the hip joint. This can often cause symptoms of pinching in the front of the hip and produce symptoms of clicking and clunking in the hip joint.

over supination and over pronation

The key to success with managing poor position at the foot, is to realign the pelvis and foot and then use supportive footwear, with the correct orthotic if needed, to hold you in the new position

In my clinic I use orthotics to improve the neurological ‘switch’ reference and they must be used in a supportive trainer/shoe otherwise it will be unable to improve position and function.

Wear on the outside of the shoe is a sign that your lower (and maybe even upper body) are in the incorrect position. The true clinical skill is to determine which neurological system is the main driver of the your altered position.

Look out for Part 2 of our Foot Position & Foot Instability Blog Series ...

Ever noticed you wear a hole through your trainers at the big toe? Find out why and what it means for your body position & risk of injury

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