Feet are far more complex than we imagine. They don’t just support us, they have a huge effect on how forces travel up into the rest of the body. Feet issues can cause problems with, not just the foot, but the knee, hip and even the back!

So many people these days are suffering with knee problems. Osteoarthritis in the knee and hip affects millions world wide and so often we can track these issues back to the feet. In past years, the focus when it comes to feet and shoes in particular, was all about supportive shoe wear. Children’s feet especially needed to be supported with shoes that supported the arch and limited movement within the foot.

With runners, we have seen years of well meaning shoe shops assessing feet and giving supportive shoes to stop over or under pronation. Aiming to support the foot and allow the shoe to take the strain. Even now, we commonly hear our clients say that they use supportive footwear so they don’t understand why their feet aren’t in great shape.

So was this the best advice and what should we be doing with our feet in today’s world?

Why supportive footwear may not be the best solution for our feet.

Out feet are designed to support us, they have a vast array of bones, joints and ligaments all designed to flex, move and dissipate forces. Crucially the way your foot hits the floor, whether you are walking, standing or running affects the direction the forces travel up into the knee and hip.

In an ideal world we would like those feet to send forces up through the centre of your knee and hip. This allows the body to safely absorb the forces, however if your foot lands on the outside or inside, rather than centrally, the forces will run up the outside or inside of the knee. Similarly, if your foot is weak, the foot tends to collapse as you walk, sending forces up through the inside of the knee. Over time, this creates pain in the knee and is implicated in later knee osteoarthritis.

This is where supportive footwear comes in. The theory is that if you use supportive footwear, this will help to keep your feet in the optimum position, allowing the forces to run centrally and saving you pain. This does work, to a level. For a period of time, you will get less pain as your foot is being aligned correctly. However, as time goes on, the orthotic element of the shoe wears and softens. This provides less support and therefore the problem can recur. Similarly, if all we do is support the feet, rather than strengthen the feet, they continue to get weaker.

The reality is that we were never designed to wear shoes. Our feet have everything they need to support us in a healthy way. In today’s world though, it is neither aesthetically pleasing, nor safe to go barefoot! So what can we do.

Strengthen those feet for a healthy body.

Feet should be wide, strong and healthy. If you have bunions, very narrow feet or a very high arch, the chances are they are not performing optimally. If you stand on one foot, does your big toe drift over to the other toes? Or does it stay wide? Wide feet, especially in the toes are essential for balance. The further the big toe drifts inwards, the less stability you have.

Again, when standing do you have a gap between your arch and the floor? The foot is meant to lift off the floor on the inside. This is so that when you load your foot it can flatten…. especially in runners…. to dissipate force. If you have a flat foot, it will still flatten, it will just go into something known as over-pronation. Over pronation is not good for your heel, your knees or your hips.

The only long term solution is to strengthen your feet and this is easily done using a towel and your foot! We have a video on how to do this, so take a look here. The video was part of our running series, but it the exercise is just as relevant to non runners. Strength lasts forever, so although it can take a while to strengthen your feet, the effects start very quickly and the investment is well worth it for the future health of your knees.

In addition, we can start to wear less supportive shoes. There is a huge array of barefoot or minimalistic shoes available these days. This isn’t a trend, or a fad, they are fabulous at building up strength in our feet. The act of walking uses all the muscles within the foot, so regularly using barefoot shoes can really help to strengthen your feet up. Initially these were only in the running community, but now your can get office shoes, dress shoes, sports shoes and lots of children’s shoes are starting to be created. As more come on the market the price is dropping, so it is well worth taking a look.

Do flat feet cause knee pain?

The simple answer to this is yes! When you place a flat foot on the floor, your knee tends to drift inwards. This is due to the foot collapsing inwards. Then when you walk the forces run up through the inside of your knee. The inside of the knee isn’t designed to absorb these forces, so it creates inflammation in the knee area. Within the muscle tendons and the joint itself in some cases.

If this goes on for a long time, this can cause the muscles on the inside of the thigh to work harder than the muscles on the outside. This can cause the kneecap to alter its alignment. The kneecap is supposed to run in a cavity, designed just for it. If it veers off from this cavity, it can cause patella tendonitis and in some cases patella arthritis. This is where the cartilage on the back of the patella rubs so much, it starts to get damaged. All these are painful conditions. Apart from treating the symptoms, the key here is to address the cause, which takes us back to the feet.

Are insoles good for knee pain?

The answer here is Yes…. and No! Insoles can be very useful if you are in a lot of pain and you just need to calm everything down. They can also help with diagnosis. If you add an arch support and the knee pain goes away, the cause is your feet and we need to start to strengthen them. If it doesn’t go away, then we need to look elsewhere in the body for the cause of the issue.

If you have the condition Mortons Neuroma, that can also be helped with an insole. In this condition, the nerve is getting caught within one of the arches of the foot, by using an orthotic to open the arch, it can help calm the nerve and reduce pain. But the long term solution to this, is again, strengthening which will naturally open the arch up.

We have had clients who have had very nasty foot injuries, where a large build up of scar tissue is affecting the arch position and in this case the use of orthotics or arch supports can be very helpful while you work through the foot issues, which can take some time.

Long term use of orthotics or arch supports, however, are rarely a good thing. If you have a true leg length discrepancy, they can be useful, those that is extremely rare. Supporting the body long term is never the solution. Understanding where the body is weak and strengthening it is really the only long term solution.

if you are struggling with you feet, or your knees, get in touch and we can give you a thorough assessment to understand where your pain is coming from and how to treat it.