For moderate to excessive pronators, the long axis of the shoe should provide maximum torsional control of foot rotation (pronation) and the midsole should provide proper vertical support. Proper support reduces shearing forces on the metatarsal heads that leads to pain and tenderness. Shoes should have a wide toe box to reduce compression of the metatarsals.
Neutral (mild pronators) – Over-the-counter orthotics with appropriately placed metatarsal support
Moderate to excessive prontators – Custom orthotics