How to Fix Supination and Prevent Painful Tailor’s Bunions

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I’ve spent years running as a "supinator"—hitting the pavement with my weight focused on the outer edges of my feet. Other than the outside of my running shoes wearing out much faster than anywhere else, I’ve never really thought much of it. That is, until I started to feel the outside of my foot more when I walked around my house barefoot in the last few weeks. At some point, I decided to check it out, and it turns out (ugh) I have a tailor’s bunion or a bunionette.

This isn’t uncommon among runners who supinate, or roll to the outer edge of their foot. Still, supination is less common than overpronation, rolling to the inside edge of your foot. Most shoe or insole recommendations are always for overpronators, so, as a supinator, I was left wondering how to fix my problem and, specifically, which shoes to look for.

To figure out how to save my feet (and my sanity), I sat down with a podiatrist and a physical therapist to unpack why supination happens and how to actually fix it.

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What Is Supination? (and Why Does It Matter)

Supination is when you roll to the outer edge of your foot as you land before pushing off in a running stride or walk. There isn’t one reason it happens, but it’s usually caused by certain foot structures and other pathologies associated with it, says Dr. Tara Parks, DTM. Often, someone who supinates will have a high arch foot, a tight Achilles tendon, potentially issues with ankle instability, and peroneal tendonitis, when the tendons on the outside of the ankle bone and the side of your foot (that connect your lower leg to the foot) become inflamed and thus painful.

When you have a higher arched foot, you’ll get a lot more stress on the perineal tendons, and that could cause you to roll outward. The opposite happens with flat feet—as you hit the pavement, your foot will overpronate or roll in.

The Mechanics of the Roll: Why Your Feet Lean Out

Supination is more often due to genetics and geometry than specific running mechanics.

“You're really talking about alignment and the way forces are applied to your feet, and that can be passively with the geometry that you have or actively with the way in which you move, or a combination of both, because it doesn't have to be one or the other,” Hilden says.

So technically, you could be running cleanly in a mechanical sense, but your body is structured in a way that causes you to roll out. Alternatively, you could be fine structurally, but strike in the wrong spot as you run.

Are You a Supinator? Look for These 3 Tell-Tale Signs

It can be fairly easy to figure out if you are a supinator. The biggest symptoms? The outside edge of your shoes will wear out much quicker than the inside edges. Other signs include a really heavy footfall.

“The people that are supinators, they don't shock absorb very well,” says Tim Hilden, MSPT, ATC, a gait analysis specialist at the CU Sports Medicine Lab and Performance Center. “So they're the people who, when they walk, you hear them on a hardwood floor.”

Confession—I’ve always been a heavy walker, and now I know why. Because supinators land more on the outside edge of their foot, they miss the ball of their foot, which acts as a natural shock absorber.

Another indicator of supination is tight calf muscles and calluses on the outside edge of the foot, often near the baby toe or on the fifth metatarsal. This long, skinny bone forms the side border of the forefoot and acts as a lever in your gait when you push off. “When you look at it, it’s another data point of where the force is occurring,” Hilden says.

How to Fix Supination

The easiest treatment for a supinator is simply using a wedge that props up the outer edge of your foot. You don’t need specific shoes or a fancy, expensive orthotic; you simply need to reduce your foot's ability to roll outward. Hilden recommends using a prefabricated rubber wedge, like this one from Amazon, that you secure to the outside edge of the shoe’s sock liner or insole.

Should You Wear a Lateral Wedge Every Day?

That’s going to depend on whether and how your symptoms continue. If nothing hurts or feels funky during your daily routines, then you can stick with a wedge just in your running shoes. If you are a severe supinator, with bowed legs, using a wedge in your daily shoes will help reduce stress on the peroneal tendons, says Hilden, who recommends using contact cement to secure it to the insole. Opt for rubber, too, as it doesn’t break down as quickly as a silicone wedge.

When to See a Pro for Gait Analysis

Not at all. If you have the obvious symptoms of supination, go ahead and try adding a wedge. If you’re still feeling pain or notice a bunion getting bigger, then it could be time to try a gait analysis.

For the gait analysis, a physical therapist will video you running or walking on a treadmill and look at everything from torso lean, arm swing, foot strike, knee and hip position, and anything else they deem a little off. With this insight, they can tell you what is causing your pain or symptoms and then work with you to change your running mechanics.

Why Supinators Get Tailor’s Bunions

I noticed the outside of my foot feeling weird when I was walking barefoot a few weeks ago. I thought maybe it was just a callus, but after taking a closer look, I realized that I was starting to develop a tailor’s bunion. A tailor’s bunion, or bunionette, is when a bunion is formed on the outside of your foot rather than the inside.

“With the Taylor's bunion, the fifth metatarsal starts to kind of push laterally, and then the fifth toe can start to move in, so it just creates more of a bony prominence on that fifth metatarsal head,” Dr. Parks says.

Think of this as an unfortunate lever. Because you’re pushing off the outside part of your foot more often, the pressure is pushing your baby toe inward, and the fulcrum has to compensate, hence a bony protrusion.

Can You Reverse a Tailor’s Bunion Without Surgery?

Because a bunion is a structural issue rather than, say, just a callus, you can’t really shrink it naturally. You can, however, stop it from growing larger with accommodations like a wedge or wider shoes. If the bunion doesn’t bother you or isn’t painful, then there’s no need for surgery.

What Is the Best Treatment for a Tailor’s Bunion?

If you try all of the non-surgical treatments first, but you are still having pain? Then it’s time to think about surgery. “If we look at the x-rays and it really looks like that bone is just protruding out, then yes, we consider surgery,” says Dr. Parks. Surgery entails shaving off the bump and possibly doing a fifth metatarsal osteotomy, which, according to Dr. Parks, is basically breaking the bone and repositioning it. Recovery typically takes about six weeks in a walking boot.

The Best Running Shoes for Supination and Tailor's Bunions

Many shoes on the market are aimed at overpronators, in which a stiffer foam is added to the shoe to wrap from the inner side of the foot to the heel. This helps to lessen the amount your foot can roll in. As a superinator, this is the exact opposite of what you want—you want your foot to roll in to offset the rolling out. Bypass stability shoes and instead aim for neutral shoes that have a mid-level of cushioning and a slight drop.

Altra Experience Wild 3

Courtesy Image

The Altra Experience Wild 3 has the brand's classic wide toebox (which is helpful if you’re developing a bunion on either side of your foot) and has neutral support, mid-level cushioning, and a 4mm drop. The neutral support is key here. In other Altra shoes that aim to improve stability, you’ll find GuideRail technology, which uses extra foam for added support to encourage a natural, not-rolled-in foot placement. As a supinator, you do not want this GuideRail technology. What you do want is the mid-level cushioning and slight drop.

“As a supinator, you don’t really need that medial arch support or extreme cushion,” says Dr. Parks, as a mega cushioned shoe could negatively impact support, like if you were trying to stand solidly on a pillow. The same goes for drop height.

“If you are a supinator with ankle instability, having a lower heel-to-toe drop would prevent it from twisting as easily, when compared to a larger heel-to-toe drop,” Dr. Parks says, warning that this could increase calf strain, so make sure you are adequately stretching.

$150 at Altra

Hoka Arahi 8

Courtesy Image

Hoka's Arahi 8 is considered a road running stability shoe, but uses Hoka’s H-Frame. Unlike J-frames or GuideRail technology, H-Frame technology has extra support on both the inside and outside of the shoe for stability from rolling on both sides. This shoe even has the American Podiatric Medical Association (APMA) Seal of Acceptance, which recognizes that the APMA considers it beneficial to foot health. According to Hoka, to earn the Seal, each product is reviewed by a group of APMA podiatrists to ensure it promotes foot health.

Does this H-Frame work better than a wedge, as recommended by Dr. Parks and Hilden? That’s debatable, but if you find a shoe that works for you, stick with it.

$150 at Hoka

Topo Phantom 4

Topo is another brand that has a slightly wider toebox to mimic the natural shape of the foot, which Dr. Parks says can help alleviate any pain on bunions. On the Phantom 4, you get a neutral, high-cushioned shoe with a slight 5mm drop. Be cautious of the super cushioned stack height—it's 35mm under the heel—but the natural foot shape and neutral support could work for a moderate supinator or someone starting to form a bunion.

$150 at Topo