How much are your feet affecting your knees?!

You may not instantly think of knee pain as being related to your feet!  Did you know that poor foot function and weakness can be directly associated with pain further up the body, in joints such as the knees, hips and even the lower back? Weakness in the feet can often present as flat feet, and this has a direct link with getting sore knees. The human body functions as one, so it is important to look at all the individual joints as well as how they function as a whole. 


The most common cause of knee pain related to the feet is excessive foot flattening or rotation changes in the arch or heel, which causes the knee to roll inwards. This can apply for both knees or sometimes just the one knee and foot. The technical name for this rotation movement is called pronation, and it may be a word you hear in your Podiatrist appointment. 


How do your feet affect your knees?

Try this simple experiment to see the relationship between your feet and knees!

  • Stand with your shoes off and feet flat on the ground to see the position of your knees
  • Now roll your feet outward so you’re standing on the outside of your feet (pinky toe side). Notice that your knees move outwards when you stand on the outside of your feet?
  • Now roll your feet inwards and notice that your knees are facing inwards. Notice that when your knees move inwards as they are following the movement pattern of flat feet! 

If your feet naturally tend to roll in or out too much, this puts increased stress on the knee joints. With the extra range of movement in the feet, this can cause pain as the foot and leg muscles need to work harder to control your movement.

What happens when feet roll in more than they should?

When the foot strikes the ground, the ankle and feet roll
inward. This action is normal for every human being and is definitely not always a problem! However, when done in excess or does not have enough strength to control this rotation, it can lead to an inward rotation of the lower leg also.

The extra inward rotation of the leg due to the movement of the foot will directly impact the structure right in the middle – the knee joint! The knee is very much subject to the relationship and movement patterns of the higher and lower joints (the hips and the feet!).

This action will have impact on knee alignment and in some cases, may cause the knee cap to not track properly. This in turn may cause misalignment of the hip, affecting the upper leg and possibly the lower back – which causes a whole kinetic chain of problems!
It’s important to remember that the foot is the first part of the body to strike the ground when we move, therefore it plays a major role in dictating the movement of the rest of the body.

What does the research tell us?

Did you know the research shows that flat feet are associated with knee pain and cartilage damage in older adults? People with flat feet are predisposed to knee pain so it is best to act with preventative treatments as early as possible. Prevention is sure to be the best medicine when it comes to our health!

In 2011 a study gathered 1903 participants with an average age of 65 years. From this number, 22% of knees were reported to be painful most days. The study found that those with flat feet had 1.3 times the odds of knee pain and 1.4 times the odds of knee cartilage damage. (Gross, K. Douglas et al. 2011). This shouldn’t come as a surprise as foot function is always closely associated with knee joint health too.

However, it’s not just the older population where we see that foot structure and function causes knee pain. We often see much younger individuals in the clinic with knee pain, many of whom are very physical and active and playing sport frequently. Often at this stage there are muscular imbalances & weaknesses to address. Flat feet in younger children will often present as a more flexible flat foot. When it comes to the management of foot and knee pain in kids it’s important to look at things like footwear, activity modification, in shoe arch supports or custom orthotics, and strength work for the feet, knees and hips. The best treatment comes from a thorough assessment when it comes to children’s pain.


Left: straight knee/foot alignment Right: flatter foot/more pronated, causing knee to rotate inward

My feet roll in. What should I do?

If you’ve noticed a flat foot or flat feet with walking or running there is a high chance that your knees could be affected. With this in mind, you should get your feet and leg alignment assessed by our Podiatrists. Being able to walk and run is an important part of our health and wellbeing, so be sure to place your treatment in expert hands!

Podiatrists are able to treat joint pain using various techniques that reduce muscle tension, joint stiffness, and improve alignment and function. When it comes to alignment or positioning of the feet, Podiatrists provide Flexible custom orthotics or arch supports which helps to add stability to the feet. Orthotic therapy allows a reduction of pressure from flatter feet and more equal force distribution. This, in turn, helps to take the pressure of nearby joints and is a great prevention strategy for the long term to protect joint function. Footwear recommendations will also be provided.

When it comes to shoes, not all are created equal. Some shoes will place extra strain on the joints as they do not have enough support. Getting into the right shoes can dramatically impact joint pain in the legs. Your Podiatrist will give you all the advice for which shoe is the right one for you!


Note the motion of the foot rotating inward , causing the knee & hip to rotate inwards

If you have any questions about boots or any foot-related questions, feel free to contact me at PodFit Modbury (08) 7226 9901.

Joe Keain
Author: Joe Keain

Joe graduated with a Bachelor Degree of Podiatry in 2016 from the University of South Australia. Since graduating he has expanded his knowledge in the areas of biomechanics and sports, completing dry needling and foot mobilisation courses.