Episode 11 | Ask the Expert | Guest: Maddie Tait BSc, MSc – Sports MSK Podiatrist, LBSM
Walk into a running shop, step on a pressure plate for thirty seconds, and there is a reasonable chance you will be told you overpronate – and handed a stability shoe to correct it. Walk away feeling like your feet are a problem that needs fixing.
LBSM’s Sports Podiatrist Maddie Tait has a different view. In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth invites Maddie to cut through the confusion around flat feet and pronation – two of the most misunderstood terms in sports health.
What pronation actually is
Pronation is not a fault. It is a normal, necessary movement that occurs in every healthy foot during walking and running. Specifically, it describes the inward rolling of the heel (the calcaneus) combined with an outward rotation of the forefoot – producing the flattening of the inner arch that most people associate with “flat feet.”
This movement is part of the natural shock absorption mechanism of the foot. When the foot pronates during the gait cycle, it loads the intrinsic muscles and connective tissues, disperses impact forces, and prepares the foot to push off efficiently. Without it, the foot is rigid and unable to adapt to variations in terrain or load.
“We need natural pronation to allow shock absorbency of our feet,” says Maddie. “In turn, that develops the strength and the intrinsic strength of your feet.”
Flat feet are not a diagnosis
Patients frequently arrive in clinic having been told, or having concluded for themselves, that flat feet are the cause of their pain. Maddie’s clinical position: flat feet are not a diagnosis. They are a foot shape – one that exists on a spectrum, varies between individuals, and is heavily influenced by genetics and ethnicity.
People of Afro-Caribbean heritage, for example, naturally tend to have flatter foot arches – and those same populations often have very strong, stable feet, developed through years of barefoot activity. The association between flat feet and weak feet simply does not hold up. “The two don’t really correlate,” says Maddie.
There is no universal “normal” foot shape. Every individual’s presentation is their own normal. Flat feet only become clinically significant when they are associated with symptoms – pain, instability, or movement dysfunction – and even then they are a contributing factor rather than a root cause in themselves.
Where the reputation comes from: when the inner arch collapses completely – an excessive rather than natural amount of pronation – this can create load patterns that contribute to pain in the foot, ankle, knee, or hip. But the leap from “some pronation” to “flat feet are causing your problems” is a significant oversimplification.
The running shop gait analysis: useful, but limited
The brief treadmill assessment offered by most running shops serves a purpose: it can identify obvious patterns and match a customer to a broadly appropriate shoe category. But Maddie is clear about what it cannot do.
Telling someone they overpronate and handing them a stability shoe to block that movement is a very simplified response to a complex picture. Restricting pronation entirely is not the goal – the foot needs to move. A more thorough assessment considers both feet independently, looks at the full gait cycle rather than a static snapshot, and takes into account the relationship between foot function and the rest of the lower limb.
It is also worth noting that the left and right foot are often different. One foot may pronate more than the other, or show a pattern of restriction at a different phase of the gait cycle. That asymmetry is relevant – a shoe prescription based on the more pronated foot may overcorrect the other.
When to get properly assessed
Most people with flat feet will never need any intervention at all. But if you are experiencing pain in the feet, ankles, shins, knees, or hips – particularly during or after activity – a proper biomechanical assessment is worth having.
Foot posture is a dynamic picture, not a static one. The foot changes shape continuously through the gait cycle, and understanding whether pronation is contributing to a problem requires watching how the foot actually moves – ideally in slow motion, on both sides, in multiple footwear conditions.
LBSM offers sports podiatry and gait assessment with Maddie, including video gait analysis in clinic and remote video consultation for those unable to attend in person. A running analysis service is also available for runners wanting a more detailed assessment of their movement mechanics.
The bottom line
Flat feet are not inherently a problem. Pronation is not something to be eliminated. The foot is designed to move, and that movement is part of what keeps it strong and resilient.
If you have been told your flat feet are causing your pain, that may be true – but it is only part of the picture, and the right intervention depends on a proper assessment of how your foot is actually functioning, not just what it looks like standing still.
Maddie Tait (BSc, MSc) is LBSM’s Sports MSK Podiatrist, specialising in gait analysis, biomechanical assessment, and lower limb injury management. She sees patients across LBSM’s London clinic sites and offers remote video consultation for those unable to attend in person.
To book an appointment with Maddie or another member of the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
