Are We Over Overpronation Yet?
“He’s taller than I realised”.
That was my initial thought when I first met Jack Chew back in May 2015 in my clinic in London. He’d travelled down South (not something I believe he is a fan of doing) so we could record a podcast episode where I was going to waffle on about feet; in particular, my dislike for the term ‘overpronation’. This recording became episode 18 of the PhysioMatters podcast. I wasn’t the first person to voice opposition against this term, but I’d been speaking about it at conferences for several years by this time. I remember laughing with Jack that soon it would be old news; a message that everyone had heard, and I would run out of material to speak about and see my lecturing work dry up. As we close in on the 9 year anniversary of that podcast, Jack asked me if I could reflect on where we are now. Are we over overpronation? I’m sorry to have to say that we are in exactly the same place, still having the same conversations daily, and I’m still asked to speak about it regularly.
A reminder of my issues with it…
As someone in his mid-forties now, I have had decisions to make. Do I fully double down and become the old man who shouts at clouds, or do I mellow and smile knowingly because it's not my first rodeo. I like to think I’ve chosen the latter, and this has been fuelled in part by another decade of clinical experience which has also included things such as motivational interviewing training and deeper reading around human psychology. As such, I rarely react at all now when someone says ‘overpronation’ in front of me, or shows me the latest trending TikTok of an influencer spewing nocebo into peoples ears with a confidence I could only dream of. That said, let us be scientists here and remind ourselves of the arguments against such a term and the flawed model upon which it is based.
That model, which I’m sure everyone is aware of, is essentially the belief that the ideal (or ‘normal’) foot sits perpendicular to the ground (vertical heel and neutral subtalar joint) and maintains a ‘normal’ arch height. Deviations from this are to be considered ‘abnormal’ and requiring intervention. The main arguments against this are:
1. It cannot be defined
We all know that pronation is just movement. Just like flexion. Just like extension. It’s normal to do it. But when does normal become abnormal? When does pronation become overpronation? The answer is that we do not know now, and we never have [1]. Absolutely crazy to think a term that has no actual definition continues to be used, but here we are.