Case study: diagnosing pronation issues - a step-by-step journey
Meet Tan.
“I’ve always been really active – walking to work, hiking on weekends, and getting in a game of golf when I can. Then, over a period of about a month, one of my ankles started swelling, and it became painful to even walk!”
Why this case study matters
Many people don't realise how important their foot mechanics are until pain or injury forces them to act. For Tan, a persistent ankle problem triggered a chain of events that led to a deeper understanding of his stride pattern—diagnosed as underpronation (also called supination).
Tan shares his experience navigating a multi-step diagnostic process for foot pain — a journey that ultimately revealed his underpronation. His story is a great example of how pronation issues (under, over, or even neutral imbalances) often need time, expertise, and a layered approach to fully understand.
Tan’s diagnostic journey - from pain to insight
Here’s how Tan’s journey unfolded over three months:
Step 1: Initial consultation - start with your GP
Tan saw his general practitioner (GP) when the ankle swelling wouldn’t go down. The GP suspected a biomechanical issue and referred him to a Physical Therapist at a sports medicine clinic.
Tip: Your GP is often the first port of call. They can identify potential red flags and refer you to the right specialists for deeper assessment.
Step 2: Physical therapy assessment
The Physical Therapist evaluated Tan’s ankle stability, foot alignment, and mobility. His ankle was placed in a moon boot temporarily, and he began a gentle exercise programme to restore motion.
The therapist noted potential stride-related issues and referred Tan for further investigation with a Sports Medicine Doctor.
Step 3: Formal diagnosis
The Sports Medicine Doctor ordered x-rays of Tan’s feet and ankles. These showed that Tan had a slight bowing of the legs, which affected his ankle joint alignment and caused underpronation during walking.
Insight: Structural patterns like bow legs can subtly affect foot strike and stride — and may only be visible through imaging.
Step 4: Integrated treatment plan
With the diagnosis confirmed, the Physical Therapist referred Tan to a podiatrist for gait and foot structure analysis.
Step 5: Podiatrist analysis and orthotics
The Podiatrist ran a treadmill gait analysis to observe Tan’s stride in real-time. A 3D foot scan was also used to map Tan’s arch height and pressure zones.
These tools helped develop custom orthotics designed to reduce strain and promote a more neutral stride.
Step 6: Footwear that works
Tan was referred to a local running shoe retailer familiar with fitting orthotics. Getting the right fit — including appropriate sizing, depth, and support — helped him transition into daily comfort.
Reminder: The wrong shoes can undo the benefits of custom orthotics. Fit matters.
The takeaway - diagnosis is a journey
Tan’s story highlights a few key lessons for anyone wondering about their stride:
It takes time: Real answers often emerge over weeks or months.
Multiple experts help: GPs, physical therapists, podiatrists, and sports doctors each bring a unique perspective.
Tools matter: Gait analysis, scans, and x-rays can reveal hidden causes.
A clear diagnosis allows for targeted treatment—from footwear changes to rehab exercises and orthotics.
Whether you suspect underpronation, overpronation, or you’re just not sure, Tan’s story shows the value of investing in a full diagnostic process. It’s not just about treating pain—it’s about understanding your body so you can move well for life.
Helpful resources
Visit our Diagnosis section for a self-assessment table and summary of some of the experts who provide professional guidance for pronation issues.
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Disclaimer
This blog provides general information for educational purposes only. It is not a substitute for professional advice. Always consult with a qualified professional regarding your specific situation.