ISSA, International Sports Sciences Association, Certified Personal Trainer, ISSAonline, Personal Trainer’s Guide to Pronation Distortion Syndrome

Personal Trainer’s Guide to Pronation Distortion Syndrome

Reading Time: 3 minutes 45 seconds


Date: 2022-09-14

Movement dysfunction patterns result from improper exercise technique and body mechanics. As a personal trainer, it’s important to know that everybody has a different structure. Some clients come to you with imbalances built through training. While others have a body structure that naturally causes them to move a certain way. 

There are different approaches to address both types of imbalances. One of the most important assessments that should be completed is on the foot and ankle complex. This helps identify pronation distortion patterns and is beneficial prior to training your client.

What is Pronation Distortion Syndrome?

Excessive pronation of the foot alters the alignment of the tibia, femur, and pelvis. Foot pronation causes the knees to rotate internally. This places more stress on the lower leg extremity. However, some clients may already have flat feet. If the entire sole touches the ground when standing, they have a flat foot. In this case, clients experience pronation distortion syndrome without having a choice to prevent it. 

On the other hand, excessive foot pronation caused by muscle imbalances can be addressed prior to getting worse. The pronation distortion syndrome is connected to what’s called knock-kneed. Knock-kneed refers to knee internal rotation and adduction. This alignment of the knees bending inward leads to foot, ankle, hip, and low back pain and other issues. Problems arise due to unwanted pressure on joints and soft muscle tissue. 

The muscle structures that stabilize the spine and pelvis are also impacted by a pronated foot. It’s common for hyperpronation of the feet to cause anterior pelvic tilt. This increases the strain on other areas throughout the body, such as the Achilles tendon, plantar fascia, patella tendon, and IT band. 

With postural distortion patterns, clients are prone to other movement dysfunction. It’s crucial to understand the effects it has on the kinetic chain and how to assess and fix the distortion.

How to Assess Pronation Distortion?

For a personal trainer, identifying pronation distortion can be as simple as looking to see if your client has flat feet. If your client has a normal foot arch, then they most likely don’t have pronation distortion. All body weight is balanced and supported by your feet. So, it doesn't matter if you're sitting, standing, walking, or running. If a client’s feet lean in, they are pronated. 

Additional areas to assess to identify pronation distortion are the client's hips, knees, shins, and ankles. Flat feet are accompanied by inward rolling of the ankles, internal knee rotation, and hip dysfunction or weak abductors. This can lead to patellar tendonitis, plantar fasciitis, Achilles tendinopathy, and tibialis tendinitis.

Learn more: Try these exercises for knee pain.

It’s crucial to assess clients and identify these problems so you can address them in training. When clients have excessive pronation of the foot, all their body weight is unevenly distributed on the lower body. This places stress on tissues and joints, resulting in inflammation and further injury.

So, how else do you assess clients besides just looking at their feet? Static assessments are effective. You can identify foot flare, internal knee rotation, bowed Achilles tendon, flat feet, and uneven shoe wear. 

Dynamic assessments such as the overhead squat can confirm what you see. During the overhead squat, if the feet flatten or turn out, you’ve identified pronation distortion. Another common imbalance to look for is the knees caving in or knee valgus while descending into the squat.  

How to Fix Pronation Distortion?

Addressing pronation distortion syndrome doesn’t just involve foot and ankle exercises. Lower body muscles and body posture creates dynamic balance. Corrective exercise and static stretch exercises can help and prevent postural sway and improve distortion. 

You will find a variety of muscle imbalance situations: some muscles are tight while others are too loose, or too weak and too strong. Tight and overactive muscles like the hips need to be loosened with static stretching and soft tissue mobilization. Weaker muscles, like the glutes and abductors, need improved isometric strength. 

Areas to loosen up include the peroneals, gastrocnemius, soleus, IT-band, adductors, and tensor fascia latae (TFL). Perform a few sets of at least 30 seconds each to lengthen these muscles:

  • A standing calf stretch can target both the peroneals and calf. 

  • A lying glute figure 4 stretch can stretch the IT band. 

  • Frog pose will stretch the adductors. 

  • A half kneeling hip flexor stretch will target the TFL. 

The weaker areas you want to focus on strengthening are the anterior tibialis, gluteus medius, and gluteus maximus. Perform a few sets of up to 15 repetitions to strengthen these areas.

  • Toe raises are an effective exercise for the anterior tibialis. 

  • Glute bridges or hip extensions will target the gluteus medius and gluteus maximus. 

Pronation distortion syndrome is a common lower body postural distortion. It leads to other movement dysfunction throughout the body and eventually injury. Prepare to assess clients prior to training with static and dynamic assessments. Once you identify issues of the foot and ankle, address them properly with systematic corrective exercise training.  

If you have a passion for both fitness and injury prevention, consider enrolling in ISSA’s Corrective Exercise program. With this certification, you can help people prevent back, shoulder, and knee pain. In addition, you will be educated on muscle-related pain and movement limitations.  


Golchini, A., Rahnama, N., & Lotfi-Foroushani, M. (2021). Effect of Systematic Corrective Exercises on the Static and Dynamic Balance of Patients with Pronation Distortion Syndrome: A Randomized Controlled Clinical Trial Study. International Journal of Preventive Medicine, 12, 129.

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