07 August 2018

Are your feet affecting your knee pain?


Knee pain, specifically patellofemoral joint (PFJ) pain is a common condition seen by clinicians affecting all kinds of people from elite athletes, to more sedentary individuals. The condition accounts for 20-40% of all knee complaints. Whilst there are multiple ways to manage this kind of knee pain, one key area often overlooked is how the feet are influencing the condition.


The condition typically presents with pain at the front of the knee, where the articulation of the knee cap and thigh bone (femur) align. With movement of the knee the kneecap needs to slide and glide over the thigh bone in a specific groove, think of it like a tram on tram tracks. If the knee cap is not sliding over the groove due to misalignment and ‘maltracking’ pain will present. Many patients describe the pain when squatting, taking the stairs or bending their knees.


There are many factors which can lead to the ‘maltracking’ of the patella, yet one area to be strongly considered is looking at lower limb and foot alignment.


In treatment, muscle imbalances are typically addressed which may involve strengthening work and exercises, however it’s important to consider if your foot alignment influencing your pain.


In 2018 the Journal of Gait & Posture published a paper examining the use of foot orthoses in the treatment of PFJ pain, they concluded that addressing foot alignment through foot orthoses affected knee mechanics through altering ground reaction forces. Whilst this is only a small piece of the puzzle  in PFJ pain research, in my experience as a Sports Podiatrist addressing patient’s foot posture (amount of foot pronation) with either prescribed orthotics or even with something as simple as footwear changes has had some great results in managing knee pain.


At Alphington Sports Medicine Clinic our Podiatrist can perform a comprehensive biomechanical assessment, focusing on your Gait (the way you walk), lower limb alignment and your foot posture. From there, they can advise you on ways to improve any postural deficits providing you with footwear recommendations and, if required, manufacture custom orthotics which may help with your knee pain.


Zoe Giacobbe

Podiatrist, Alphington Sports Medicine Clinic


Citation: Burston. J, Richards. J, Selfe. J, 2018, The effects of three quarter and full length foot orthoses on knee mechanics in healthy subjects and pattelofemoral pain when walking and descending stairs, Gait and Posture,62 p518-522.