Supination and pronation are terms used to describe the up or down orientation of your hand, arm, or foot. What it means can depend on which part of the body it describes.

When your palm or forearm faces up, it’s supinated. When your palm or forearm faces down, it’s pronated.

When supination and pronation refer to your feet, it’s a little more complicated. Both terms involve your gait and how your weight is distributed as you walk or run.

  • Supination means that when you walk, your weight tends to be more on the outside of your foot.
  • Pronation means that when you walk, your weight tends to be more on the inside of your foot.

An easy way to remember the difference is that supination has the term “up” in it.

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Pronation and supination are terms used to describe the motions observed at the foot and ankle during movement.

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. Your pronation should be neutral.

Looking at the back of your foot and leg, your heel, ankle, and knee should form a straight line.

Excess supination

If you have excess supination, it causes stress on the outer side of your foot when you walk or run. Your shoe will show uneven wear on the outside part of the sole.

If you supinate, it can cause excess strain on your ankles. It may lead to shin splints, calluses, or bunions on the outer side of your foot, and pain in your heels and balls of your feet.

Excess supination is also called underpronation.

Excess pronation

Excess pronation, or overpronation, means that as you walk, your foot rolls toward the inside and your arch tends to flatten out. Your shoe will show uneven wear on the inside part of the sole.

Overpronation is more common than underpronation.

If you overpronate, you may develop pain in your:

  • arch
  • heel
  • ankle
  • shin
  • knee
  • hip
  • back


It’s likely that you were born with feet that tend to overpronate or underpronate. This may be because your arch is too high or your leg lengths aren’t even.

But it can also result from injury, overuse, or walking or standing on hard surfaces. Overpronation may also result from obesity or pregnancy.

Possible injuries

If you’re a runner, power walker, or athlete and your pronation isn’t neutral, it’s a good idea to see a professional for a gait assessment and treatment.

Orthotics or special shoes may help you avoid:

Your doctor, trainer, or physical therapist can also suggest stretches and exercises to help you walk and run properly.

The forearm is the lower half of your arm, from your elbow joint to your hand. It’s composed of two long bones: the ulna and radius. The ulna remains stable, while the radius rotates to supinate or pronate your hand.

When your palm and forearm are facing up, they’re supinated. When they’re facing down, they’re pronated.


The forearm is a common location for injury in falls, crashes, and sports. Forearm injuries are especially common among children. Forearm breaks in one or both bones account for most limb fractures.

Forearm injuries are common in sports, especially racquet or throwing sports. Overuse and other injuries of the forearm that affect the nerves in the elbow or wrist may make it painful to pronate or supinate your arm.

Forearm and wrist injuries may also come from overuse in playing a musical instrument, sewing, or other repetitive work with your arms and hands.

Both radial tunnel syndrome and pronator syndrome are common injuries of forearm overuse in sports that involve excessive flexion of your wrist or pronation-supination movement.

  • Pronator syndrome is caused when the muscles in your forearm compress the median nerve in your arm. It causes pain and numbness in your arm that may extend to your palm. It may be painful to make the OK sign.
  • Radial tunnel syndrome is caused by entrapment of the radial nerve.

Your wrist is an extension of your forearm. It can’t supinate or pronate on its own. Supination and pronation of the arm come from arm movement, not wrist movement.

Specific wrist movements includes flexion, extension, and side-to-side movement of the hand.

Wrist injuries related to sports are common. About 25 percent of all sports-related injuries involve the wrist or hand.

Wrist injuries that may affect arm movement include carpal tunnel syndrome, which comes from pressure on the median nerve in the wrist.


Excess pronation or excess supination in the foot is well studied in sports medicine. It can cause an imbalance in your body’s alignment that leads to pain in your:

  • feet
  • legs
  • knees
  • hips
  • back

Treatment is usually conservative, and it’ll depend on the severity of the problem. The aim will be to correct the imbalance and help you avoid injuries.

A foot professional can analyze your gait and the extent of your excess pronation or supination. They may suggest orthotic insoles to correct your misalignment or a heel lift for one foot, if your legs are different lengths. In some cases, you may need special footwear or splints.

Some types of injuries, such as plantar fasciitis, respond to kinesiology taping.

The right shoes

Wearing well-fitting, supportive shoes is important. People with excess supination or pronation need shoes with proper cushioning and plenty of toe room. Fortunately, today there are plenty of sports shoe choices.

People who have excess supination need cushioning, flexibility, and support in the heel to balance the outward roll of the foot. Those with excess pronation need a more stable shoe with a firm midsole and heel cushioning.

If your doctor has recommended orthotics, you’ll need to find a shoe that fits you and can accommodate the orthotic.

Look for a good shoe store with an experienced fitter to help you. Or bring your new shoes to a podiatrist or physical therapist to check them out before you start wearing them.

Physical therapy

Your doctor may refer you to a physical therapist for gait analysis and a stretching and exercise routine that you can do at home. Manual therapy may also be useful if you have foot or leg pain related to your supination or pronation.

Forearm and wrist

The first line of treatment for forearm and wrist injuries is conservative:

  • protect or stabilize the area with a brace or splint, especially at night
  • modify your activities
  • rest
  • ice the area
  • elevate your arm
  • use nonsteroidal anti-inflammatory drugs (NSAIDs) to help with pain and inflammation
  • work with a physical therapist on stretching and strengthening exercises

A health professional may use an instrument called a goniometer to measure your arm range of motion, including supination and pronation, before and after treatment and physical therapy. The goal is for you to regain full range of motion.

When conservative treatment isn’t enough

If you have a forearm fracture or wrist fracture, the bone fragments will have to be aligned to grow back correctly. Your arm will be immobilized in a splint, brace, cast, or sling to aid in healing.

The doctor may recommend physical therapy while your arm is healing. After the splint or cast is removed, they’ll likely suggest physical therapy to help you regain strength and flexibility in your arm.

The nerves in your arm may also be injured or pinched from overuse. If conservative methods don’t relieve the pain, your doctor may suggest:

  • a splint to immobilize your arm or wrist
  • a corticosteroid shot for pain and inflammation reduction
  • as a last resort, your doctor may recommend surgery

It’s a good idea to see a doctor if you have any foot pain. This can be your regular doctor or a foot specialist, also called a podiatrist. You may also get help from a physical therapist, a sports trainer, or a chiropractor.

A gait analysis from a professional can help:

  • improve the way you walk or run
  • prescribe orthotics to make your pronation neutral
  • advise you on the best kind of shoes
  • give you stretching and strengthening exercises to deal with excess pronation or supination

If you have pain in your forearms and wrists, a professional may prescribe a splint or brace to stabilize your arm and wrist. They can also give you specific exercises and stretches to help strengthen your arms.

Supination and pronation are terms used to describe up or down orientation of your hand, forearm, or foot.

If your feet are supinated or pronated in excess, it can throw your body’s alignment off and make you prone to injuries. It’s important to see a doctor and get treatments that can help correct your stance.

For athletes or people who play sports involving racquets or throwing, overuse can cause problems with supination and pronation of your arms. Overuse may also lead to nerve damage, which needs to be treated.