What Is Supination?

Supination is a term used to describe the upward rotation of your forearm or foot. When your palm or sole is face-up, it is supinated. This is the opposite of pronation, which is the downward rotation of the forearm or foot.

Forearm and Hand Supination

When you supinate your hand, the forearm and palm are being turned to face out, a thumbs-out position. This results in your thumb being on the far side away from your body and the pinkie finger closer to your body.

If you were to do this when your arms are at your sides, the palms are facing forward, anteriorly. If you supinate your hand while your arms are over your head, the palm is facing backward.

Supination in the Feet

In a normal gait cycle, the foot is slightly supinated at the time the heel contacts the ground, but then it pronates, turning up and out to absorb the shock of the step.

As the full weight of the body comes on the foot when the foot is flat on the ground, the foot supinates, twisting in and down as it takes on the load and continues to supinate during the propulsive push-off stage.

As such, supination is a normal part of how the foot moves throughout a step. It is when either pronation or supination motion is excessive that they become something that may need to be addressed or corrected.

Under-Pronation

When your foot is supinated, the sole is facing in, toward the ankle of the opposite foot. This is done with the ankle of that foot rolling out and the toes and sole facing in. This is also called under-pronation or having high arches.

If you were to look at the front of the leg when the foot is supinated, you would see the big toe angled in and the ankle angled out from the midline. It involves plantar flexion, adduction, and inversion of the foot.

Over-Supination

Over-supination or being a supinator describes having an excessive outward rolling motion of the foot and ankle during a walking or running stride.

You can look at the wear pattern of your shoes for a clue as to whether you are a supinator. Excessive wear on the outer edge of the sole is an indicator of supination.

Supination is more common in those with high and inflexible medial arches and can lead to foot aches and pain. Their stiff arches aren't good shock absorbers. They may develop conditions such as iliotibial band syndrome, plantar fasciitis, shin splints, and knee pain.

Wearing the proper footwear, and using shoe inserts/insoles, or orthotics can help reduce supination. Supinators should not use motion-control shoes, which are designed to correct the opposite condition (over-pronation). They should look for neutral shoes and flexible shoes.

What Causes Supination Problems?

Supination in your forearm means that your palms are facing up. Your arms are supposed to be able to turn up this way. 

If you cannot turn your arm this way, it’s usually a sign of a problem with the bones, muscles, or joints involved in making the movement For example, getting an overuse injury to your elbow can make it harder to rotate your arm this way.

If you have supination problems in your feet, it’s not normal and will affect how you walk. 

There are some things that can make you more likely to have supination problems in your feet, and they’re not all things you have control over. For example, if supination “runs in your family,” you’ve probably inherited a gene that makes the condition more likely to affect you. 

There are also risk factors you can change. For example, wearing shoes that don’t fit correctly is a potential cause of supination problems that you can fix. 

There are also causes and risk factors that are a mix of things that are in and out of your control. For example, the way your body is shaped and aligned is not always something you can change but sometimes, doing certain exercises to improve your posture can help. 

Similarly, you might not always be able to prevent an injury to your foot that could lead to supination problems. You can, however, make it less likely that you’ll hurt your foot by taking precautions when you’re exercising or playing sports.

How Are Supination Problems Diagnosed?

If you’re having trouble turning your arm, your provider can use a combination of range of motion tests and imaging scans to look for a problem. Sometimes, it’s fairly easy to diagnose the cause—for example, if you’ve broken your arm.

Providers who specialize in caring for the feet (podiatrists) and physical therapists (PTs) are often able to tell that you have supination problems just by watching you walk and looking at your feet. 

You might be able to tell that you have supination problems in your feet by looking at your shoes—if the outer edges are worn down more than the rest of the shoe, it could indicate that you do not have neutral supination when you walk.

How Supination Issues Are Treated

If you have problems supinating your arm, you’ll need to treat the underlying cause. This can include rest if you’ve got an overuse injury, wearing a brace or cast, or possibly having surgery if the injury is severe. Physical therapy might also be part of your recovery, as it can help you learn how to move your arm properly again. 

Supination problems in your feet are not always something you have control over. For example, you can’t change your genes or the way your feet are shaped. That said, you might be able to treat or even prevent supination by:

• Wearing shoes that fit and are designed for the activity you’re doing
• Adding orthotics to your shoes (especially if you’re on your feet a lot)
• Finding ways to improve your posture
• Checking that you’re using the right form and technique when you’re doing physical activity, exercise, and playing sports
• Working with a physical therapist (PT)

If supination is severe and cannot be fixed with the right footwear and treatments like PT, a specialist might recommend that you have surgery to correct it.

Summary

Supination means turning your arm with your palms up. It’s a normal movement for your arm, but you might have trouble doing it if you have an injury. 

In your feet, supination is not normal. It means that your foot and ankle roll out too much when you walk. Over time, this can cause pain and discomfort. 

Some people are born more likely to have supination, but it can also be caused by wearing shoes that don’t fit or are not right for an activity you’re doing (like playing sports) or an injury. 

You can often correct supination by getting the right footwear and working with a physical therapist. If it’s severe, supination can also be fixed surgically. 

A Word From Verywell

Being able to supinate your arm correctly is important for a range of daily tasks. If you’re not able to turn your arm or move it through its full range of normal motion, figuring out the cause and getting treatment is important to your recovery.

Supination in your feet can cause a lot of pain and discomfort when you’re going about your daily activities and trying to engage in exercise and sports. 

That said, there are some things you can do to try to fix the problem. Even if you were born with a genetic tendency toward supination, it doesn’t mean you can work on improving it. 

Wearing the right shoes and learning exercises that will strengthen the supportive structures in your feet, ankles, and legs can be very beneficial for supination.