Running Is in the Knees and Ankles

Pronated runners less likely to get injured than those with supinated or neutral feet

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) A lot of hardcore runners have proper running form on the mind. Another concern they may have is foot posture, or the way the foot and ankle can roll in or out. Does foot posture make a difference in staying injury-free?

A recent study found that runners with pronated feet, or feet that fall slightly inward towards the middle of the body, were less likely to get injured while running than people with other kinds of feet.

The findings contradict the belief that moderate foot pronation can increase injury risk among novice runners, according to the researchers.

"Work with a personal trainer to learn proper running form."

Rasmus Nielsen, a PhD student in the Section of Sport Science in the Department of Public Health at Aarhus University in Denmark, led an investigation into running-related injuries among novice runners with different foot postures.

The study included 927 runners who were 37 years of age on average. Each of the runners' feet was measured and categorized into one of five groups based how they turn in or out.

Foot groups consisted of supinated, pronated, highly supinated, highly pronated and neutral. Supination means that the foot and ankle tend to roll out while pronation means the foot and ankle roll in.

Of the participants, 369 had supinated feet and 53 had highly supinated feet. Another 122 had pronated feet and 18 had highly pronated feet. The rest of the participants had a neutral foot position.

Each of the participants ran in a running shoe designed for neutral feet. The researchers tracked all musculoskeletal complaints in any part of the lower body and back caused by running.

The researchers also noted the distance each person ran during each training session using a global positioning system.

In total, 252 participants were injured while running, with 63 of the injuries caused by bilateral issues, or problems with body alignment. Collectively, participants ran a total of 326,803 kilometers (about 203,066 miles) until they were injured.

The researchers found no difference in the chance of getting injured between each of the foot categories.

During the first year of running, 17.4 percent of runners with neutral feet were injured. Rates of injury among supinated runners, highly supinated runners and highly pronated runners were even higher, at 17.9, 24.5 and 33.3 percent, respectively.

Runners who were pronated had significantly fewer injuries than those who had neutral feet. A little more than 13 percent of pronated runners were injured.

"No significant difference in distance to first running-related injury were found between highly supinated, supinated, pronated and highly pronated feet when compared with neutral feet," the researchers wrote in their report. "In contrast, pronated feet sustained significantly fewer injuries per 1,000 kilometers of running than neutral feet."

After 500 kilometers (about 311 miles), about 71 percent of legs were still injury-free.

The researchers noted some limitations to their study, including that they had few participants with supinated feet compared to those with neutral feet. 

In addition, participants who had an injury involving only one leg were allowed to stay in the study, which may have skewed the results. The time spent in recovery after the initial injury was not taken into account.

The study was published online June 13 in the British Journal of Sports Medicine.

One of the authors was a consultant and received grants for his work with Smith and Nephew in Hoersholm, Denmark.

Funding for this study was provided by the Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg Hospital, Aarhus University and the Danish Rheumatism Association.

Review Date: 
June 23, 2013
Last Updated:
September 6, 2013