How much are your feet affecting your knees?!You may not instantly think of knee pain as being related to your feet, but poor foot function and weakness can directly be associated with pain further up the body in joints such as the knees, hips and even the lower back.

The most common cause of knee pain related to the feet is excessive foot flattening or rotation, which caused the knee to roll inwards.

How do your feet affect your knees?

Try this simple experiment!

  • Stand with your shoes off and feet flat on the ground and 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 in and notice that your knees face inward again

Notice that your knees move inwards, which is the movement of the knees when the feet roll in

If your feet naturally tend to roll in or out too much, this puts increased stress on the knee and can cause pain as the muscles need to work harder to reduce this excessive 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, however when done in excess it
leads to an inward rotation of the lower leg also. This action
will have in impact on knee alignment and in some cases, may
cause the patella-femoral groove not to track properly. This in
turn may cause misalignment of the hip, affecting the upper
leg and possibly the lower back – thus completing 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 that flat feet are associated with knee pain and cartilage damage in older adults?
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 medial tibiofemoral cartilage damage,
associating foot morphology with knee pain and cartilage damage in older adults. (Gross, K. Douglas et al. 2011)
However, it’s not just the older population that can be affected by poor foot function. We often see
much younger individuals in the clinic with knee pain, many of whom are very active or playing sport at a high level. Often at this stage there are muscular imbalances & weaknesses to address.


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’re worried about the structure or function of your feet potentially affecting your knees, you should get your feet and leg alignment assessed by our Podiatrists.

We are able to treat any joint pain or swelling using various techniques to reduce muscle tension, joint stiffness, and provide advice on strengthening exercises to work on correcting the alignment and function. Flexible custom orthotics may be prescribed to lift the arches, control pronation and provide support as well as reducing impact on other joints. Footwear recommendations will also be provided.


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.

With you every step of the way!

Joe Keain
Sports Podiatrist
P: (08) 7226 9901
E: joe@podfitadelaide.com.au