Is foot pronation a predictor for injury? Can it be corrected with shoes?

Question

Retailers of running shoes talk about "pronation" and the risks it causes and how shoe choice can help.

For examples, Asics claim:

Pronation refers to the way your foot rolls inward for impact distribution upon landing. [...] People who roll inward too much or not enough can experience running injuries due to less effective shock absorption - which is around 60% of runners.

However, some people argued the evidence for the claim that pronation is (consistently) predictive of injury is poor. Sports Podiatrist Ian Griffith, blogged about this in 2011, and this forms the basis of the Subreddit r/running's wiki's article on the matter.

The blog proposes that this is not founded in science, but has been proposed in a very old (1940's) paper and simply repeated since then.

On the contrary, it seems that there are papers which show that the assumptions or arguments are plain wrong (many references in the blog entry).

Well, it has generally been thought that a more pronated foot type is a significant risk factor for injury. However the fact is that there are very few prospective studies which have actually shown this, with numerous studies actually concluding that there is no association between foot type and injury. Two studies have even shown that a pronated foot is actually a protective factor against injury.

Ten years later, what does the evidence show? Do runners who pronate tend to get more injuries? Do "stabilizing" running shoes lead to fewer injuries?

N.B. My question is about the choice of running shoes, not whether barefoot running is better than with shoes.

Answer 1

I'm not sure if there's a recent definitive review/synthesis on this topic, especially regarding shoes, but:

• Regarding the risk from pronation, a 2014 meta-analysis of 21 studies by Neal at al. found that:

There was strong evidence that a pronated foot posture was a risk factor for medial tibial stress syndrome (MTSS) development and very limited evidence that a pronated foot posture was a risk factor for patellofemoral pain development, although associated effect sizes were small (0.28 to 0.33). No relationship was identified between a pronated foot posture and any other evaluated pathology (i.e. foot/ankle injury, bone stress reactions and non-specific lower limb overuse injury).

• Regarding shoes it's probably more complicated, e.g. Nielsen at al. (2013) has a rather self-evident title: "Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study." (Contra to the above meta-analysis, this study also found that "pronators had a significantly lower number of injuries/1000 km of running"). Whereas Malisoux et al. (2016) finds that motion-control shoes help limit injuries in runners with pronated feet (hazard ratio=0.34; 95% CI 0.13 to 0.84). There's a 2021 paper from roughly the same research group, finding similarly. (Based on the similar numbers reported, this seems to be some kind of re-analysis rather than a new study.)