Pronation is a phenomenon that is entirely necessary to help modulate the body’s response to impact forces and for planning subsequent motor plans at all three levels of feedback and feed forward mechanisms. Overpronation, however, can lead to a gamut of ugly things over the long haul and should at least be noted in your athletes.
Approaching the overpronator relies upon the results of an effective screening and assessment process at intake as pronation and flat feet are far more complicated than algorithmic exercise progression.
One thing you may consider in assessment is having the athlete walk for you normally then have them pigeon-toe walk to see how easily the athlete can “create” an arch and the difference between normal and pigeon toed. If they cannot form an arch take them off the ground and see what happens. Does the mobility exist so you can create one for them if need be? If no arch can be formed at the most elementary of levels, refer them to somebody who has a different toolbox and who may be able to build them an orthotic that brings the ground to their foot, which will help address the problem.
If they can create an arch either in non-weight bearing or weight bearing and mobility is clean we’ll simply work on it in concert with our other training goals and means. If mobility is lacking, we’ll begin with mobility work at the distal segments to get the STJ and talocrural joints playing better, while simultaneously take a top down approach with our strength/control training by beginning with work about the core. The beauty here, too, is that many of the FMS 1s and 2s can be dealt with simultaneously if you are smart about your exercise selection.
We first need to program proper torso and hip rotational stability training (that do not have to be all stability exercises) and also address the position of the innominate on the ipsilateral side. If the pelvis is locked into anterior rotation, the femur will move more easily into FA IR and cause a chain reaction that flattens the foot. In many cases a good manual therapist can expedite this process for you by freeing up the hips and erectors. Strength work targeting the core with anti-rotational work, breathing retraining (recall the continuity of the oblique system and the intercostals), and gluteal complex work can go a long way in bringing the arch back to life. If your athlete is TFL dominant, you’ll need to clear that up as well as that can lead to expansive issues. When your athlete has adapted to those demands and are is need of bigger challenges things like forced pronation (an RNT technique essentially) in increasingly complex patterns can be your next progression.
You also need strong anti-pronation musculature at the foot, those being the foot intrinsics, which we can hit with some small foot training first in isolation then quickly and progressively into more difficult positions with destabilizing torques adding challenges to the overpronator. The short foot should become part of all functional activities in weight bearing just like we should with C-spine position barefoot or not. Likewise, simple barefootedness may have an advantage in helping us get an arch back if all of the anthropological literature’s suggestions hold true. Given their large amount of afferent nerve endings and pronation’s potential role in motor planning, more foot contact can potentially reduce the need for overpronation without even changing foot posture (in theory, of course).
Up the shank, balancing the tib posterior, peroneals, and tibialis anterior may be helpful. I prefer to do much of this type of work eccentrically as that is more gait specific, and it needs to be done with adequate STJ mobility into eversion and inversion for maximum effect. Tibialis anterior work can be good as well, and I’ll squeeze some of that into warm ups of those overpronators.