Knee Pain: Why It Often Starts at Your Feet

Knee pain doesn't always start in the knee. As a pedorthist in Nelson, BC, many of the knee complaints I see in clinic trace back down the chain — to how the foot strikes the ground, how the arch loads, and how that motion travels up through the tibia and into the knee joint with every single step. If you're dealing with knee pain that flares with walking, hiking, or standing through a work shift, the answer might be sitting in your footwear, not just in your knees.

What Is Knee Pain & Lower Limb Mechanics?

The knee is a hinge joint, but it doesn't operate in isolation, it's sandwiched between two joints that love to rotate: the hip above and the subtalar joint (ankle/foot complex) below. For example, when the foot overpronates or the arch collapses excessively inwards during our walking, the tibia internally rotates more than it should, and that rotation gets transmitted straight up into the knee. Over time, that repetitive mechanical stress can irritate the patellofemoral joint (kneecap), the IT band, or the medial structures of the knee.

This is why I ask every knee pain patient about their footwear and evaluate their gait before we talk about anything else.

Why Does It Happen?

Foot mechanics - Overpronation or a low/collapsed arch increases internal tibial rotation, which alters patellar tracking and increases load on the medial knee compartment. On the other end, supination or a high, rigid arch reduces the foot's natural shock absorption, sending more force up the chain and increasing lateral knee and IT band stress with each step.

Muscle imbalance - Weak hip abductors or a poor quadriceps-hamstring balance often show up alongside poor foot mechanics, whether that's overpronation or a rigid, supinated foot, compounding knee stress in either direction.

Footwear - Worn-out or unsupportive shoes lose their ability to control excess pronation or cushion a rigid, supinated foot, leaving the knee to absorb forces the foot should be managing either way.

Training load - Sudden increases in hiking, running, or standing time without adequate lower limb support can overwhelm tissues that were already compensating.

Leg length or alignment differences - Even small discrepancies can change loading patterns at the knee over thousands of repetitions during our walking / gait cycle.

How We Treat It

Treatment starts with a full biomechanical assessment — we look at your gait, your foot posture in calcaneal stance, and how your knee tracks through movement. From there, care usually involves a combination of approaches:

Custom orthotics - Correcting the underlying foot posture, whether that's controlling excess pronation or adding support and shock absorption for a high, supinated arch, reduces the rotational and impact stress reaching the knee. This is often the single biggest lever we can pull for mechanically driven knee pain, regardless of which direction the foot fault runs.

Footwear guidance - Matching you with shoes that support your specific foot type and activity level, whether that means more arch support and motion control for an overpronated foot, or more cushioning and flexibility to help a rigid, supinated foot absorb shock. The right shoe won't fix a mechanical issue on its own, but the wrong shoe can undo the work your orthotic or brace is doing, so we make sure the two are working together rather than against each other.

Knee bracing - For patients dealing with patellar tracking issues, mild ligament instability, or knee joint irritation that needs additional support during activity, we also fit and provide knee braces in clinic — including the BORT select StabiloGen®, a compression-class support with a contoured pad designed to stabilize the patella and relieve pressure on the knee joint during loading. For patients who need both foot-level correction and knee-level support, orthotics and bracing often work together rather than one replacing the other.

Activity modification - Short-term adjustments to training, hiking distance, or time on your feet at work while irritated tissues settle down. This isn't about stopping activity altogether, it's about temporarily dialing back the specific loads that are aggravating things so the rest of the treatment plan can actually take hold.

What Happens If You Ignore It

Mechanically driven knee pain rarely resolves on its own if the underlying cause — which usually in our line of work is often from dysfunctional foot mechanics isn't addressed. Left unmanaged, it tends to get worse with continued activity, and compensations elsewhere (hip, low back, the opposite leg) can start to develop as you unconsciously offload the sore knee. What starts as an ache after a long hike can become a persistent limitation if the mechanical driver isn't corrected.

When to Come In

If you're noticing knee pain that tracks with activity, worse after hikes, long shifts on your feet, or a new training block, it's worth having your gait and foot mechanics assessed before the pattern sets in further. Whether the right approach is a custom orthotic, a properly fitted knee brace, or a combination of both, we'll walk you through what's actually driving the pain and build a plan around it.

We proudly serve Nelson, Kaslo, Castlegar, Trail, Rossland, and the Slocan Valley. If knee pain is holding you back from the trails or your daily routine, book an assessment with us — let's figure out what's going on and get you moving comfortably again. Give us a call at 250-352-1384.