Is Underpronation Contributing to Your Forefoot Pain?

By Emily White|2025-09-22T07:43:28+00:00July 20th, 2025|

Forefoot pain can be complex and multifactorial, particularly when several conditions overlap. Common forefoot conditions that often present concurrently are plantar plate injury, intermetatarsal bursitis, and Morton’s neuroma. A common biomechanical factor linking these pathologies is underpronation, also known as excessive supination during gait.

What is underpronation?

Underpronation describes a gait pattern in which the foot rolls outward (supination) rather than inward (pronation) upon ground contact. This results in diminished shock absorption and a concentration of ground reaction forces through the lateral and central forefoot. Over time, this abnormal loading pattern may predispose an individual to the three following forefoot conditions:

Plantar plate injury involves damage to the ligament beneath the metatarsophalangeal (MTP) joints, most often under the second toe. This structure stabilises the toe and prevents it from drifting upward or sideways. When injured, it can lead to pain, swelling, and visible toe deformity.
Intermetatarsal bursitis is inflammation of the small fluid-filled sacs that cushion the spaces between the metatarsal bones. This condition causes localised forefoot pain, especially with weightbearing or pressure.
A Morton’s neuroma is a thickening of the interdigital nerve usually between the third and fourth toes. It is caused by repetitive compression or irritation. It can produce burning pain, tingling or the sensation of a small object under the foot.

When these conditions present simultaneously, patients may experience significant discomfort, altered gait mechanics and difficulty tolerating footwear.

What can I expect it to feel like?

Patients with forefoot pathologies associated with underpronation typically report significant discomfort worsened with weightbearing, difficulty tolerating footwear and an altered gait pattern. Other symptoms may include burning, tingling, sharp discomfort between the toes, focal swelling or the sensation of walking on a stone.

Diagnosis is established through a detailed clinical assessment that can be performed by the podiatrists at our Melbourne clinic. This assessment may be supplemented by diagnostic imaging such as ultrasound or MRI to evaluate soft tissue integrity, inflammation and neuroma presence.

How can I treat underpronation?

Effective management for pathologies associated with underpronation involves a multifaceted treatment strategy, tailored to the individual’s presentation and contributing biomechanics. Interventions may include:

Footwear modification, prioritising forefoot cushioning, shock absorption, and adequate width
Targeted rehabilitation, including exercises to enhance intrinsic foot stability and ankle mobility
Offloading techniques, such as taping, padding or metatarsal domes
Custom foot orthotics to improve pressure distribution and support optimal gait mechanics

Surgical intervention may be considered for chronic or refractory presentations where conservative management has been exhausted.

How can I prevent forefoot pain in the future?

Underpronation is often overlooked, however its role in the development of forefoot pathologies is significant. Booking a foot check at our Melbourne podiatry clinic will assist in early identification of underpronation and associated compensatory patterns. Biomechanical assessment and gait analysis performed by one of our podiatrists can help detect abnormal load distribution before significant pathology develops.

Our podiatrists are experienced in providing preventative strategies such as footwear advice, strength and conditioning programs and custom orthotics which can assist in mitigating your long-term risk.

A comprehensive, biomechanically informed approach is essential for both treatment and prevention of chronic forefoot pain. So, if forefoot symptoms are impacting your mobility or quality of life, seeking a professional assessment from one of our experienced Melbourne podiatrists can provide clarity and direction for effective, personalised care.