When pain shows up in your knee or hip, it feels natural to assume the problem lies there. But the human body is a chain of connected joints and muscles, and often the true cause of pain is not where you feel it. One of the most common examples of this is when foot and ankle issues quietly set the stage for knee or hip discomfort.
This may sound surprising, but when you think about how much work your feet do, it makes sense. They are your foundation, carrying your body weight, absorbing shock, and guiding your movements with every step. If there is a problem lower down in the chain, the joints above often pay the price.
How the Feet Influence the Knees and Hips
Your feet are made up of 26 bones, over 30 joints, and a complex network of muscles and ligaments. They are designed to move in subtle ways that keep the rest of your body aligned. When they are not moving or supporting you correctly, the effects can travel upwards.
Here are a few examples of how this works:
- Flat feet or fallen arches: When the arch collapses, the foot tends to roll inwards (overpronation). This rotation pulls the shin and thigh inward too, straining the knee and hip joints.
- Stiff ankles: If your ankle does not bend properly, your body has to compensate higher up the chain, often by twisting at the knee or hip during walking or exercise.
- Uneven weight distribution: Something as simple as favouring one foot or wearing worn-out shoes can create imbalance and overload in the joints above.
Over time, these changes affect your movement patterns. The knee may start to feel sore around the kneecap, or the hip may ache after standing or walking for long periods.
Common Pain Patterns Linked to the Feet
Different foot and ankle issues tend to show up as pain in slightly different ways. Here are some of the most common connections physiotherapists see in clinic:
- Foot or ankle stiffness → Hip tightness: When the ankle does not move well, the hip muscles may tighten up to compensate, leading to aching hips.
- Overpronation (rolling in) → Inner knee pain: This puts stress on the inside of the knee joint, sometimes mimicking arthritis-like symptoms.
- High arches → Outer knee or hip pain: A rigid high arch often reduces shock absorption, pushing more force into the knees and hips.
- Unequal leg loading → Low back discomfort: If the feet are imbalanced, the chain reaction may extend even higher, into the lower back.
These patterns do not mean every case of knee or hip pain comes from the feet, but they are worth considering—especially if scans or tests on the painful joint show nothing significant.
Common Pain Patterns Linked to the Feet
Different foot and ankle issues tend to show up as pain in slightly different ways. Here are some of the most common connections physiotherapists see in clinic:
- Foot or ankle stiffness → Hip tightness: When the ankle does not move well, the hip muscles may tighten up to compensate, leading to aching hips.
- Overpronation (rolling in) → Inner knee pain: This puts stress on the inside of the knee joint, sometimes mimicking arthritis-like symptoms.
- High arches → Outer knee or hip pain: A rigid high arch often reduces shock absorption, pushing more force into the knees and hips.
- Unequal leg loading → Low back discomfort: If the feet are imbalanced, the chain reaction may extend even higher, into the lower back.
These patterns do not mean every case of knee or hip pain comes from the feet, but they are worth considering—especially if scans or tests on the painful joint show nothing significant.
Why Physios Look Beyond the Painful Joint
One of the key principles in physiotherapy is the regional interdependence model. This simply means that joints and muscles in one area can affect pain and movement in another.
When a patient comes in with knee pain, a physiotherapist will often check not just the knee, but also how the hip and ankle are working. The same applies to hip pain—sometimes the source of the issue is lower down.
By assessing how the foot and ankle move, and how the body loads through them, a physio can spot whether the pain is being driven by poor mechanics at the base of the chain.
What You Can Do to Help
If you suspect your feet may be contributing to your knee or hip pain, there are a few simple steps you can take:
1. Check Your Footwear
Shoes play a big role in supporting your body. Worn-out soles, lack of cushioning, or poor arch support can all add stress to the knees and hips. Switching to well-fitted, supportive footwear often makes a noticeable difference.
2. Strengthen Your Feet and Ankles
Simple exercises such as calf raises, arch strengthening, or balancing on one leg can improve stability and reduce stress on the joints above.
3. Stretch Where Needed
Tight calf muscles or a stiff ankle joint can throw off your walking and running mechanics. Gentle calf and ankle stretches can restore some mobility.
4. Build Hip and Knee Strength
Since the whole chain works together, strengthening the hips and thighs alongside the feet is vital. Squats, bridges, and resistance band exercises can improve control and reduce overload.
5. Seek Professional Help
A physiotherapist can assess whether your pain is coming from the feet and design a tailored plan. This may include hands-on treatment, exercise prescription, and advice on footwear or orthotics if needed.
When to Get Checked Out
If your knee or hip pain has lasted more than a couple of weeks, is getting worse, or is stopping you from enjoying daily activities, it’s a good idea to seek professional advice. Pain that keeps moving around, feels worse with certain shoes, or is linked with old ankle injuries is especially worth investigating from a foot and ankle perspective.
Final Thoughts
Knee and hip pain can be frustrating, particularly when the cause is not obvious. Sometimes the problem is not where the pain is felt, but in the foundation that supports you—your feet. Subtle changes in how your feet and ankles move can gradually strain the joints higher up the chain.
By paying attention to your body’s alignment and seeking advice early, you can often resolve these issues before they become long-term problems. A good pair of shoes, some targeted strengthening, and the right physio guidance can go a long way in keeping you pain-free and moving well.
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