It's a combination of factors, but could be based on each person individually. I've had moderate pronation for a while now, but only recently have I actually started to struggle a bit with it in regards to skates, shoes, and foot pain. For me: - I have a narrow ankle with not a ton of volume, so I need a skate that has a lot of support and a narrower ankle pocket. I've tried interior and exterior wedges/shims in the heel area, but nothing addressed in the heel area has really helped MY pronation in any way. - Arch support is the big one for me. I need a fairly significant arch support in any skate I wear. I'm currently obtaining this through Graf SIDAS custom insoles. I used Sole brand insoles in the past and obtained similar results, but the Graf SIDAS is a step above. This has made one of the biggest differences for me. - Mid-foot width is part of the equation too. If you have extra space it is easier for your foot to roll/pronate if you're already prone to do so. I usually require a boot with narrower mid-foot width too, but still wide enough to fit custom insoles and wider forefoot. - Boot length for me also comes into play. I pronate more when wearing a half size larger. - In all of my skates I have to put a wedge/shim between the blade holder and the outsole on the outside side of my foot at the front of each skate. If done properly this doesn't seem to have any effects on the durability of the holder long-term. Depending on the skate I'll also need to put a lift under both sides of the front portion of the holder to reduce the pitch, or change the pitch of the runner. - Other: Yeah, a few other factors come into play, for me: I have a lot more problems when I'm wearing a longer shin pad (16"). If I drop down to (15") it seems that everything stays in line better. Also, boot pitch and cut are a big factor. I found out the hard way that I can't wear Graf skates because the aggressive pitch puts even more pressure on my pronating toes. My best combination for pitch seems to be in the Bauer Supreme line with Tuuk LS2, but I'm also OK in Easton RBII with some blade work. I need to wear a boot that is a bit higher cut and with a lot of support. Graf G75 didn't do it for me, way too much range of motion at the ankle (designed for more power, better stride). This also means that I need to be in a boot that is quite stiff, so no bargain basement skates for me. Anything lower models that tend to break down easily don't provide enough support. When I'm actively running a few times a week (2k-5k) I seem to have less pronation issues. When I go to the chiropractor regularly for adjustments I have less issues too. Lastly, I've noticed that posture and skating stance makes a huge difference. If I'm not skating properly, meaning proper skating stance, goofing around on the ice, playing a low division where I'm not really caring too much, I pronate more and my feet and ankles start killing me. When I'm keeping all the things I learned in power skating classes as a kid in mind the problem is noticeably better. These are the things that I've noticed based on a ton of expensive, frustrating, and lengthy trial and error over a period of approximately 1.5 years. Will they work for everyone, well, maybe not. Do they make sense scientifically/medically, I don't know, I'm not a doctor/scientist. I've literally kept a log book of my trial and error and experiences over time. What I tried, what worked, what didn't, and the above are simply my conclusions. Call me nuts, but these skate problems have nearly driven me to hang up the skates over the last little while, so I can definitely appreciate anyone's struggle with pronation or skate fit.