Hi guys! In this video, I'm going to talk about supination of the feet, so, where you walk on
the outsides of your feet. We're going to look at what causes it, because there's a different
few … a few different things, we're going to look at why does it cause trouble for some people and
not for others, and then of course, we're going to look at how you can treat it; are there exercises
that you can do to improve it, and can shoes and orthotics and things like that maybe help as well?
So, for those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
your injuries. Have a look at the description of this video if you want a link to our website.
Okay, so, what is supination of the feet and why does it happen? Now,
when we walk, it's natural for us to land on the heel, and then you curve a little bit
into supination, come into pronation, and then you push off from your big toe, a little bit
back into neutral. And there's a big variation in how much of that happens in different feet,
and there's a wide kind of range of what's seen as normal. Now, some people tend to walk very
much on the outside of the foot, and they don't really get that pronation, coming over to the big
toe and pushing off, and it can predispose you to some sort of injuries like … easier to get stress
fractures on the outside of the foot, because that's where most of the strain is going to be.
Now, in a large part, what makes you supinate is very much down to biomechanics and how your
foot's formed, and it's very likely genetic. So, for a large portion of the population,
to supinate is natural because of how their bones are formed, and there's not much you can
do to change that. But don't worry; if you think that's you, there are still things that you can do
to prevent injuries from happening through that, and I'll talk about those in a minute.
Now secondly, it can sometimes be an adopted way of walking because of a different injury you've
had. So typically, if somebody has a tib post tendinopathy or pain on the inside of the foot,
it's quite natural to try and avoid the pain by trying to walk on the outsides of your feet,
and then that can become habit and that can become problematic, because it's not normal for you,
and you should be walking in a normal way. So, it could be a learned behaviour that you've got.
Then, it can also be hand-in-hand with that … Sometimes people try to pronate or they
over-pronate. So, they've been told that their feet roll in too much or they know their feet roll
in too much or they've got flat feet, and they're trying to correct it by purely rolling their feet
out onto the outsides. Now, that's not really how you should be correcting over-pronation or flat
feet. I've done a whole video on that, which shows you how it's actually about pulling the arch up,
as well as a little bit of correction there, but not too much. And if you want more information
about that, there's a link to that video in this one; you could also look in the description. So,
it can be over-correcting for that. And then lastly … what was the last point there? Oh
yes! It can be down to your … to things higher up and the way that you walk. So for instance,
if you've got a crossover gait, where you walk or run as if you're running on a tightrope,
then you're more likely to end up supinating your feet just because of where you place them.
So, if ... that can predispose you to that. But it's also, sometimes a crossover gait is a symptom
of having weak glutes. So, to compensate for that, people can bring their feet closer to the midline,
and then it's also likely to make them supinate more. So, we'll talk about that
all under treatment in a minute. Now, let's first talk about, what if it is genetics? So, your feet
are shaped in a certain way that causes you to supinate more. It's important to understand that
just because you supinate when you walk or run does not mean that you're going to get injuries.
There are loads and loads of people who run and walk and have done so for years without
any issues. It's about if there's something that changes in your training load, that that part of
the foot suddenly overloads and doesn't get enough recovery time that it can cause trouble. So,
it's always useful to think about what happens when we exercise or do a new activity:
The body gets micro-trauma in all the tissue that's being used, and that's normal,
it's part of the process. But then it has to recover and repair that micro-trauma over
several hours before you do another workout. If you don't give it enough recovery time,
then the micro-trauma can accumulate and that can then cause injuries. Now, what can often happen
is, if you've not done sport or a lot of activity for a period of time and then you suddenly ramp up
the amount you do – so, either the volume or just the intensity of it – then the body will likely
not be strong enough to cope with all that load. So, you will get more damage than normal if you
did small increases, and you won't have enough time to repair. So then you're going to have
overuse or very likely get overuse injuries, and the part of the body that develops those
in overuse injuries will be the parts that take most strain. So, if you're somebody who supinates
when you walk, then it's likely going to be something to do with the outside of the foot,
either the muscles or the tendons along there, peroneal tendinopathy or a stress fracture there.
But it's not actually the fact that you supinate that's caused that injury;
it's the fact that you've overloaded it too quickly. So, your training load went up too
quickly. So that's important to know, because people can often get fixated on,
“Oh, I've got to stretch this, I've got to strengthen that to get this right,” and meantime,
if you hadn't supinated, something else in the body would have had that injury because
you increased your load too quickly. So remember that, and if you have trouble with that, just look
at your load, what you've been doing, and see if that's not part of the problem. And when we think
of training load, it doesn't have to be running or jumping or stuff like that; it can literally be,
you’re used to walking a couple of miles twice a week, and then you've suddenly decided, “I want
to walk every single day, and I want to go for three to four miles at least.” That's a massive
increase of load; your body wouldn't have had time to adapt to it. So, first check that box, because
that's the most common reason why I find patients get trouble on the outside of their foot when they
supinate; it’s just that they've increased the load too quickly. If they do it slowly
and at a pace that the body can adapt, they grow strong in those positions, and it's not an issue.
Now, shoes can be a problem as well, because if you're already supinating and then you buy a shoe
that's super flexible and is really not stable, it can increase how quickly that supination happens,
and then that can predispose you to injuries that strain the outside, like the tendons and
things like that. So also, that's another thing to first check: Either, are your shoes too old, so,
have they been worn out and now they’re stuck in a position of supination, so they're increasing that
moment for you, or are they too flexible? Now, they don't make specific shoes to stop supination.
All you need is a neutral shoe that's nice and supportive that's not too flexible.
An example of a shoe that's too flexible – I can't remember the Nike brand exactly,
the name – but if you can take a shoe and you can pretty much twist it around, that's too flexible.
It should have a bit of a twist, a gentle one, but it shouldn't be like, “Oh,
I can wring it out like a like a towel,” – that's too flexible.
Then also, sometimes if you're really struggling, getting orthotics with a little wedge on the
outside of the foot – in this part – that stops it from quite supinating all that much,
that can be useful, because it can stop your foot from rolling over too much.
You can get those off the shelf, that you get … prefab, but to be honest, it's usually best to
see a podiatrist for this type of thing, because it's not … as cust … it's not as easy to get one
that's right for you as it is for the pronation type orthotics … those are pretty standard,
anything that just stops it rolling. So, it's best to have it seen to by a podiatrist who can
check that the wedge is right and actually needed. Okay, then, what if your supination
is something … well, it could be that you're genetically predisposed to it, but you've learned
or taught yourself to supinate even worse than what you should, or if it's something that you've
learned through the years because of injury or just the way that you walked when you were
younger - what can you do to improve that? Now, I'm going to go through quite a few exercises,
and it's mostly about becoming aware of your foot and the control of the foot. Now, whenever I make
a video like this, I always google what is the stuff that comes up most, and it's so annoying,
because nine times out of ten it's exercises and things that's really not the main focus or should
not be the main focus that people are shouting about on the Internet. So, when I googled this,
everybody was saying, “Oh, you've got to stretch your muscles to become more flexible to stop the
over … the supination.” Now yes, stretches can be useful, because things can become tight if
you walk in that way for a long period of time, but it's not the main cause of supination. So,
stretching can be a useful part of your rehab, but please don't get fixated on stretching too much,
because you can overstretch very easily and actually cause aggravation of your tendons.
Also if you already have irritation of your peroneal tendon because of your supination, do not
over-stretch into dorsiflexion – which is that position – because that usually just
ends up irritating that tendon. So, I'm not going to talk about stretches, because for me
that's not the main part that I get my patients to treat or to work on. I get them to work on
becoming aware of how their foot should move, and also strengthening the muscles, that it can
actually support it through that range of motion, because they won't be strong enough for that.
Good! So, let's have a look at that before we get to the last bit. So, how do you teach
yourself to become aware of your foot? Now, there's different stages for this,
and the exercises I show you are not necessarily in the order you should be doing them;
some of them will work for you, some won't. So, it may be useful to work with somebody to figure this
out. But I'm going to give you a good overview of the type of things that could be useful. So,
the first thing is becoming aware of where your foot is in space. Now, if you've watched my videos
about over-pronation, I go a lot into just doing things with your toes without actually moving
your whole foot, because that means that you're actually aware of how you can move individual toes
and things without having to move the rest of your body. So, the first thing I like to start with
is, just in sitting, can you feel the pressure under your big toe, so, the ball of the big toe,
ball of the little toe, and your heel? And while you're sitting there, is your pressure more onto
the outsides of your feet, more onto the insides of your feet, or pretty ... kind of in the middle?
So, what you want to do is, you want to become aware of that pressure and just correct it. So, if
you're finding that your pressure is way ... even in sitting ... is on the outsides of the feet,
then see if you can just bring it slightly back to there. But watch out, you don't want to see
that you're doing … you're moving your legs to do that; this needs to stay still; it needs to
be a movement of the foot to get that pressure there. So, that's the first thing to check.
Then, an exercise that's super annoying but can be quite good to teach you
individual movement of the toes is toe yoga, where you just try to lift your big toe up,
keeping the others on the floor, and then placing the big toe down, and lifting the
other guys up. But again, what you don't want to see is massive turning out to lift that up or
rolling the feet in to turn, you should only be moving your toes and not really
the rest of your foot, okay. So, practice that a bit, and try not to get too annoyed with it
if it's difficult. You can use your fingers to help it guide it as well at the beginning.
Good! Then the next thing in sitting – because it's easier in sitting to just concentrate on
that – is if you imagine doing a heel raise, where you lift your heels up off the floor and come up;
where does your weight go when you do that? Do you feel yourself naturally moving onto the outsides
of your feet? That's supination. Do you feel yourself moving in? What you should try and do
is come up, keeping that straight in the middle, and avoid that little twist out at the top – so,
keep it in a straight line – and slowly back down. And you want to concentrate on it while you're
doing it. So, you're not just doing it in front of the TV, thinking of other things; you want
to feel, “How do I make my foot move through that line where I want it to move through?”
okay. Now, before we get to the standing exercises:
Likely, if you've been walking on the outsides of your feet, the muscles that support you when
you're in a position where you're in a neutral position may not be strong enough to sustain
that for a long period of time. Now, the more you practice these exercises, the stronger they get,
and the more you'll be able to support yourself. But it can be useful to do the band exercises,
where you do for tib post tendon as well as your tib ant tendon, that just support the inside of
the arch. And if you want to see those properly explained, I've done them in the over-pronation
video. So, you can use that video as well to get those exercises. And they are the ones with the
band where you pull in, and with the band where you pull up; those are the ones that can work for
that bit. Okay, so, if we think of then going into standing and doing the same type of stuff. So,
in standing, the first step is to feel, where do you carry your weight while you're standing?
Do you feel that it is equal between those three points, or do you feel that you naturally
want to stand on the outsides of your feet? Then correct that for me, but try to correct it without
over bringing your legs in. So, try to make sure that it's the ankle that mostly corrects it;
your knees will obviously move as you do that as well, because it is connected, but try to make
it that it’s the feet starting the movement rather than the knees leading the movement. Okay, now you
know how it feels to be there, can you now go up on your toes while you're holding onto something,
but not allowing your feet to supinate at the top? So, can we do little lifts in a
straight line without supination? And if you struggle with that, only go that high. So,
start with very little movement and just practice how does that feel when you go up and down,
okay? And then you can obviously start going through the full range as you can.
Natural progression from that is doing it on one leg, but again, you want to see that you don't
supinate while you're doing it. Something else that's a simple exercise – before the
single leg up and down's even – is to feel what happens when you balance on one leg:
Are you able to keep that position without rolling it in overly and without rolling it out overly?
So, are you able to balance, keeping the pressure the same under all three of those points?
So, that's a very good exercise for this as well. What else am I missing out? Yeah. So then,
if we think of … Those would be the stuff I would typically do to get you to understand
how your foot's moving and how you control it, and I wouldn't do all of those in one;
I would master one of them first … get you to master one of them first, then go the step up.
But then, you do want to look at how strong are your glutes; can they actually
support you? When you go into a single leg balance, is there a big shift when you shift
over? Because then it may mean that actually you need to strengthen your glutes a bit as well.
Strengthening all the muscles in the leg can already help as well, because that will help
support the muscles lower down. But then also, have a look at your running gait.
If you run and you kick yourself a lot on your ankles, there's a chance that you may actually
be running with quite a narrow gait – we call that tightrope running. And it may help if you just try
to separate your legs a little bit when you put them down, so that you don't run on a tightrope
or walk on a tightrope, but you try to get them slightly more in line with your hips when you go.
Doesn't have to be totally in line, just a tiny bit of a change will already make a difference.
Good! So that's where exercises are concerned. Then … Oh, one of the silly claims that I saw
on the Internet was also: “If you do a good warm-up and a good cool-down, it will help
your supination.” That's absolute rubbish! And I think the person just put it in there to
rank well on Google. Warm-ups and cool-downs are good for general injury prevention,
but it's not going to change your supination. The last question people always ask me is, “Will these
exercises truly help?” Now, that will depend on how … what's causing your supination. So,
if yours is caused by genetics – so, the shape of your bones – then the exercises may help a bit,
because it will take out the extra supination that you've got. But you will always supinate more than
another person who doesn't have that build, and it doesn't have to be a problem. It's load management
that's going to be your most important part of your treatment. Then, if your supination is
because of a habit you taught yourself to do, then likely these exercises will make a difference,
but it's not going to be, “Oh, I've done it for two weeks and now I'm better.” You're going to
have to commit at least three months to see some good changes, and then even longer than that to
really embed it in your movement patterns. Then also, age will make a difference. If you're young
and your supination is a recent thing that you've taught yourself or happened because of injury or
things, the exercise will have a bigger effect on you, because you don't have permanent changes in
your biomechanics yet. If you're over the age of 50 or 60, then the changes may not be as dramatic
from the exercise, because you may have permanent changes then in shapes of bones, shapes of knees,
or things like that that's changing it. But it's always worth trying some exercises and
getting your mind kind of around how you walk and looking at the shoes you wear; change those easy
things first before you really get stuck into things that's much more difficult to change.
Excellent! Hope this was useful. And remember, if you need more help with an injury, you're welcome
to consult one of us via video call – link is in the description of this video. Take care!