Do you have pronation distortion syndrome? (60-80% 0f people do)

Foot conditions such as plantar fasciitis, metatarsalgia, neuromas and bunions can be due to local problems, in addition to   abnormal muscle and joint function at the joints located above, specifically the knee, hip and lumbar spine.

Pronation distortion syndrome  is a fancy term to describe  excessive foot pronation (flat feet) with concomitant knee internal rotation and adduction (“knocked-knees”).

This lower extremity distortion pattern can lead to a chain reaction of muscle imbalances locally leading to foot and ankle pain and proximally, to  knee, hip and low back pain.

Research has  shown that excessive pronation of the foot during weight bearing causes altered alignment of the bones of the leg and thigh (tibia and femur) and can lead to rotational stresses at the lower extremity and pelvis.

These mechanical stresses cause  increased strain on soft tissues and compressive forces on the joints, which can become inflamed and over time, arthritic.

The low back and hip alignment has been shown to be directly affected by hyperpronation of the feet, which results in an increased  anterior pelvic tilt of the lumbo-pelvic-hip complex.

In fact, as little as  2-3 degrees of foot pronation can  lead to a 20-30% increase in pelvic alignment while standing and 50-75% increase in anterior pelvic tilt during walking.

Since anterior pelvic tilt has been correlated to an increased lumbar curvature, the change in foot alignment might also influence lumbar spine position.

Furthermore, an asymmetrical change in foot alignment (e.g.  from an ankle sprain) may cause asymmetrical lower extremity, pelvic, and lumbar misalignment, which might perpetuate symptoms or dysfunction.

By  understanding this distortion pattern and its effects throughout the kinetic chain, it becomes evident  how these  stressors to the soft tissues and joints can lead to achilles tendonitis, plantar fasciitis, IT-band syndrome, and low back pain,  all of  which are commonly seen in recreational runners and walkers as well as competitive athletes.


When assessing for pronation distortion syndrome, both static and dynamic assessments should be performed.

During a static assessment,  the arches of the feet are observed for flattening and/or turning out.

A dynamic assessment, such as the overhead squat, commonly shows the  feet flattening and/or turning out and  the knees adducting and internally rotating (knee valgus).


Corrective  Strategies for Pronation Distortion Syndrome

Functionally tightened muscles that have been associated with pronation distortion syndrome include the peroneals, gastrocnemius, soleus, IT-band, hamstring, adductor complex, and tensor fascia latae (TFL).

Functionally weakened or inhibited areas include the posterior tibialis, anterior tibialis, gluteus medius and gluteus maximus.

The Key to an Effective Treatment Includes:

First, inhibit the muscles that may be tight/overactive via dry needling style acupuncture and myofascial release. Key regions that should be addressed would include the peroneals, gastrocnemius/soleus, IT-band/TFL, bicep femoris and adductor complex. Follow-up with self-myofascial release as a home corrective exercise.

Second,  lengthen the tight muscles via static stretching. Key muscles to stretch include the gastrocnemius/soleus, TFL, bicep femoris and adductor complex. Hold each stretch for  30-60  seconds  and perform 1-2 sets of each stretch.

Third, activate the underactive muscles. Key areas to target with isolated strengthening are the anterior tibialis via resisted dorsiflexion, posterior tibialis via a single-leg calf raise, gluteus medius via wall slides and gluteus maximus via floor bridges. Perform 1-2 sets of 10-15 repetitions.

Lastly, perform an integrated exercise to improve muscle synergy to enhance neuromuscular efficiency and overall movement quality. An example of integration exercise would include a multiplanar single-leg balance reach while maintaining neutral foot and knee alignment. Perform 1-2 sets of 10-15 repetitions.


Pronation distortion syndrome is a common lower extremity postural distortion pattern that can lead to other movement dysfunction patterns throughout the kinetic and ultimately pain/injury.

By incorporating static and dynamic assessments of the kinetic chain,  this distortion pattern.can be identified.  Once identified, following a systematic manual therapy and corrective exercise strategy, can help to improve functionality and movement quality, leading to decreased risk of injury and resolution of the problem.

(This week’s blog modified from the NASM corrective strategies for pronation distortion syndrome)

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin