Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Understanding Supination
Supination — also called underpronation — describes a foot that rolls outward (laterally) during the loading and mid-stance phases of gait, rather than inward (pronating normally). The result is a rigid, poorly cushioned foot that transfers impact forces laterally through the fifth metatarsal and lateral heel, rather than distributing them across the entire plantar surface.
Supination is most commonly associated with high-arched (cavus) foot structure. The rigid high arch fails to deform under load, acting as a poor shock absorber. The lateral ankle bears disproportionate stress, predisposing to ankle sprains. The fifth metatarsal is at high risk for Jones fractures in supinating runners.
Common Injuries in Supinators
Lateral ankle sprains are the cardinal injury of supinating runners — the lateral ankle ligaments are chronically stressed by the inverted loading pattern. IT band syndrome (discussed separately) is strongly associated with high-arch supination. Peroneal tendinopathy develops as the peroneal muscles work overtime to prevent excessive supination. Jones fractures (fifth metatarsal base) occur from the lateral forefoot stress of supinated running. Plantar fasciitis also occurs in high-arch feet due to the rigid arch’s inability to absorb fascial tension.
Footwear and Insole Selection for Supinators
Supinators need: maximum cushioning to compensate for poor natural shock absorption, flexible midsoles that allow normal pronation to occur, and neutral (not motion-control) shoes. Best choices: HOKA Bondi 8, Brooks Glycerin 21, New Balance 1080v14, Asics Gel-Nimbus 26. Avoid all stability and motion-control shoes — these add medial posting that further prevents the minimal pronation supinators are capable of.
Insoles for supinators should be flexible, cushioning-focused, and without a rigid medial arch post. A cushioned full-length insole (low-profile arch) or no insole change is appropriate. The PowerStep Low Profile insole is the OTC option best suited for high-arch supinators.
Dr. Tom's Product Recommendations
CURREX RunPro Insoles
⭐ Highly Rated
For supinating runners, CURREX RunPro Low arch profile provides cushioning and dynamic flexibility without adding the medial arch post that would worsen supination mechanics. The dynamic flex zones allow the limited pronation that supinators are capable of to occur naturally.
High-arch supinating runners, IT band syndrome, lateral ankle protection
Overpronators (need Medium/High arch profile); avoid rigid arch insoles in supinators
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Identifying supination prevents the common mistake of prescribing wrong shoes
- Neutral cushioned shoes dramatically reduce supination-related injury risk
- Addressing supination simultaneously manages IT band syndrome, peroneal tendinopathy, and ankle sprains
- Ankle stability training reduces lateral ankle sprain recurrence
❌ Cons / Risks
- High-arch foot mechanics are structural and cannot be fully corrected by shoes/insoles
- Supination is frequently misidentified — many patients are given motion-control shoes incorrectly
- Rigid cavus foot may require custom orthotics for adequate accommodation
- Jones fracture risk is structural and requires awareness even with correct footwear
Dr. Tom Biernacki’s Recommendation
The classic mistake I see with supinators is they’ve been told they need arch support. They buy motion-control shoes and their lateral ankle problems get worse. A supinator needs cushioning and flexibility — the exact opposite of what motion-control provides. First thing I do: throw out the stability shoes and get them into a neutral maximum-cushion shoe. The lateral ankle problems usually resolve within a training cycle.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How do I know if I supinate when running?
Look at the wear pattern on your current running shoes — supinators wear through the outer edge (lateral side) of the heel and forefoot. Gait analysis at a specialty running store confirms supination objectively.
Can supination be corrected?
The underlying high-arch structure is largely genetic and structural. Supination can be managed with appropriate footwear and insoles, and secondary injuries can be treated. Custom orthotics can reduce but not eliminate supination mechanics.
Is supination worse than overpronation?
Neither is inherently worse — both are biomechanical variants that cause different injury patterns. Supination is less common (approximately 10–20% of runners) than overpronation.
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.