Extended Abstract
1.    Introduction
Foot pronation is a natural rotational movement occurring at the subtalar joint, primarily during the early stance phase of gait, and is characterized by ankle dorsiflexion, forefoot abduction, and rearfoot deviation. However, the high prevalence of pronated foot across children, adolescents, and adults suggests that this motion frequently exceeds its normal range and manifests as excessive pronation (1). Evidence indicates that excessive foot pronation is associated with lower-limb malalignment and an increased risk of musculoskeletal injuries (2,3). Excessive pronation alters lower-limb kinematics and kinetics during weight-bearing activities and may lead to increased internal rotation of the tibia, knee, and hip, as well as greater dynamic knee valgus. These biomechanical alterations have been linked to pathological knee conditions such as patellofemoral pain and knee osteoarthritis (4,5). Moreover, an increased external knee adduction moment (KAM), a well-established risk factor for knee osteoarthritis, has been associated with excessive foot pronation, potentially increasing medial knee joint loading (6). Excessive pronation has also been implicated in overuse injuries including plantar fasciitis, medial tibial stress syndrome, and Achilles tendinopathy (7–9). As pronation severity increases, structural changes in the foot—particularly a reduction in the medial longitudinal arch—impair the spring-like function of the midfoot, leading to greater energy dissipation and increased oxygen consumption during walking. Individuals with pronated feet commonly exhibit shorter step length, wider step width, and reduced gait efficiency, necessitating greater compensatory work at proximal lower-limb joints (10,11). Biomechanical evidence further suggests that individuals with pronated feet demonstrate altered ground reaction force patterns and loading rates during walking and running, which may contribute to injury risk (12–14).
Various interventions have been proposed for the management of excessive foot pronation, including foot orthoses, motion-control footwear, shoe insoles, therapeutic exercise, taping techniques, and gait retraining (12,15–17). While passive supports such as orthoses and insoles can redistribute plantar pressure and correct rearfoot alignment, active exercise-based interventions—particularly those targeting intrinsic foot muscles and proximal musculature such as the gluteal muscles—appear to offer additional benefits by enhancing medial arch support, improving balance, and optimizing neuromuscular control (18,19,25). Given the functional and clinical consequences of excessive pronation, a systematic evaluation of rehabilitation interventions and their effects on walking and running mechanics is warranted.
2.    Methods
This study was conducted as a systematic review. Relevant articles published between January 2018 and March 2025 were identified through searches of the Web of Science, Scopus, PubMed, Google Scholar, the Scientific Information Database (SID), Magiran, and the Islamic World Science Citation Database (ISC). Searches were performed in both Persian and English. The following keywords were used, alone or in combination: pronated foot, foot orthosis, arch support, exercise interventions, walking biomechanics, running, lower-limb injuries, muscle activity, and shoe interventions. The inclusion criteria were as follows: (1) studies involving individuals with pronated feet; (2) studies reporting quantitative (numerical) and/or qualitative (descriptive) outcomes related to biomechanical changes and motor function; (3) studies examining the effects of interventions on walking and/or running in individuals with pronated feet; and (4) studies investigating therapeutic or rehabilitation interventions. The exclusion criteria included studies involving participants without pronated feet, studies employing non-standard or inappropriate methods for evaluating therapeutic interventions, studies published before 2018, and studies for which the full text was not accessible or not relevant to the study objectives. Based on the initial screening, 82 relevant articles met the inclusion and exclusion criteria. After full-text assessment and methodological evaluation, 21 high-quality studies were selected for final review and analysis. The methodological quality of the included studies was assessed using the Downs and Black checklist (31).
3.    Results
A total of 82 articles were initially identified. Of these, 11 articles were excluded due to duplication or publication prior to the target period, 31 articles were excluded because they did not include rehabilitation interventions, and 22 articles were excluded because they did not examine walking or running tasks. Ultimately, 21 studies published between 2018 and 2025 met the inclusion criteria and were included in the final analysis. Among these, 11 studies focused on rehabilitation interventions during walking, and 10 studies examined interventions during running. According to Table 1, the total sample size across studies investigating the effects of rehabilitation interventions during walking between 2020 and 2024 was 235 individuals with pronated feet. This sample included one study conducted exclusively in women (27), two studies that did not report participant sex (23, 24), two studies involving both men and women (5, 27), and five studies conducted exclusively in men (8, 23, 25, 28, 29). The assessment tools used across these studies included surface electromyography in four studies (23–26), foot orthoses in four studies (25, 26, 30, 41), three-dimensional motion capture systems in two studies (8, 27), force plates in two studies (5, 29), and the Foot Posture Index in one study (24).
Rehabilitation interventions included exercise-based programs such as seated and standing exercises (23), short-foot exercises, intrinsic ankle muscle strengthening, and toe-walking exercises (24), aquatic exercises and resistance training using elastic bands (24, 26), short-term and long-term use of foot orthoses (23, 27–29), footwear and insoles (5, 27), walking-based interventions (8), and breathing techniques combined with strengthening exercises (23). Studies employing short-foot exercises combined with breathing techniques reported increased activation of the tibialis anterior, tibialis posterior, and abductor hallucis muscles (23). Toe-walking exercises were also shown to enhance intrinsic ankle muscle function and strength (24). Findings from insole and orthotic interventions indicated increased mean frequency of the rectus femoris and medial gastrocnemius muscles during the loading phase, increased frequency content of the vastus lateralis during mid-stance, and reduced ankle deflection moment during walking in individuals with pronated feet. Orthotic use was also associated with a 5–15.4% reduction in plantar fascia loading.
In addition, orthotic interventions improved cadence and stride length during running compared with non-orthotic conditions. Orthoses were further shown to influence knee mechanics by increasing knee adduction moment, reducing adduction angle, increasing external torque, and decreasing mediolateral ground reaction forces during walking and running in both men and women with pronated feet (5, 23, 27–29). Finally, studies examining aquatic training with elastic bands and combined theraband-plus-orthotic interventions reported long-term increases in electromyographic activity of the gastrocnemius and semitendinosus muscles (24, 26). 

Table 1. Review of rehabilitation interventions during walking in people with pronated feet

4.    Discussion
The findings of researchers who used strengthening exercises, including leg shortening exercises and toe walking exercises, to strengthen the intrinsic muscles of the foot, concluded that these exercises increased the activity of the tibialis anterior and posterior muscles, the abductor hallucis longus, and improved the plantar arch in the pronated foot during walking in people with pronated feet, especially as a result of strengthening exercises for the intrinsic muscles of the foot (23, 24). These findings indicate that different training methods, either through direct strengthening of the intrinsic muscles or through changes in the movement pattern, can lead to increased stability and efficiency of the leg motor system in people with pronated feet during walking. The advantages of the present research include the large sample size and the comparison of biomechanical variables during walking as a result of comparing the two training conditions. Rehabilitation interventions such as exercise, the use of theraband, kinesiotape, and the use of various orthoses, shoes, and insoles during walking and running can generally help correct movement, reduce stress, and prevent injuries. These interventions usually improve muscle function and motor stability, which ultimately helps reduce pain and joint damage in people with pronated foot. 

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 
Authors' contributions
All authors equally contributed to preparing article.
Conflicts of interest
The authors declare that there are no conflicts of interest associated with this article.