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Bunion Treatment Seattle

Knee Pain and Your Feet

What causes knee pain?
There are many causes of knee pain. Some of the more common ones include patellofemoral pain syndrome, arthritis, injury to ligaments, cartilage (me¬niscus) tears, tendonitis and bursitis. Some of these problems are caused by direct injury, and some can be the result of wear and tear over many years.

Is my knee pain related to my feet?
Abnormal foot function can cause several types of knee pain. Your feet are the founda¬tion for every step you take. Problems with the function of your feet can have repercus¬sions that are felt all the way up, including your knees, back and hips.

In studies of knee pain and foot function, excessive flattening of the feet (pronation) is the foot problem most often mentioned in the literature as being associated with knee pain This occurs because pronation of the foot causes the knee to rotate inwards so that it is forced to function in an abnormal position.

Here’s a little experiment you can do to demonstrate this point.

Knee Rotation

  • Stand with your shoes off and feet flat on the ground.
  • Look at the position of your kneecaps.
  • Now role your foot so that you are standing on the outside of your feet.
  • Note how your knees face outward, away from each other,
  • Flatten your feet again and notice that your kneecaps move back to the inside.


When your feet roll in (flatten) or roll out (arch raise) too much, then the leg and knee rotate inward or outward – leading to increased stress on the knee.

Treatment Options
Treatment for knee pain is as varied as the number of causes. It is very important that you understand the cause of your symptoms before undergoing treatment for your knee pain. Our first job is to determine if your foot function may be contributing to your knee pain. We determine this through an evaluation and by possibly making you a temporary orthotic to determine how it affects your pain. If we feel that your knee pain is not related to foot function, we will refer you to an appropriate specialist.

How can foot orthotics help reduce knee pain?
If after an examination we feel your knee pain may be related to foot function we may recommend custom foot orthotics – along with shoe changes and/or modifications. The right custom-made orthotics can address the underlying cause of your knee dysfunction. In fact, several studies have shown the dramatic effect that orthotics can have on knee problems.

Studies in 1997, 2002 and 2004 showed a strong scientific basis that custom orthotics with specific types of wedging are effective in reducing pain in persons with medial knee osteoarthritis.1-3 In a 2005 study of 30 persons with medial knee osteoarthritis, subjects were given foot orthoses with a 5 degree lateral wedge. At 6 weeks, all subjects had some relief and 28 found the orthoses comfortable.3

In a 2003 study of 102 athletic patients with patellofemoral pain syndrome, 76.5% of patients improved after 2-4 weeks of receiving the custom foot orthoses.6 A 2004 study showed significant improvement of patella-femoral pain with the use of foot orthoses.5

What type of orthotics work best for knee pain?
Research studies have shown that the best orthotic prescription varies depending on what type of knee problem you are experiencing. A person with pain on the inside of the knee needs a very different orthotic than someone experiencing pain on the outside of the knee.1-6 In addition, orthotics for knee pain often require adjustments after the patient has worn them for a few weeks. For most knee problems, but not all, orthotics should conform very close to the arch of your feet (Total Contact Foot Orthotics). All of this is why it is absolutely critical that anyone who is prescribing orthotics for you be an expert in casting, prescribing and troubleshooting foot orthotics. Both Dr. Huppin and Dr. Hale are experts in orthotic therapy and our practice is a referral center for patients needing state-of-the-art biomechanical treatment.

If you are experiencing knee pain and want to find out if treating your foot function might help reduce your knee pain, then call today for an appointment in our Seattle clinic.


What is patellofemoral pain syndrome?
Patellofemoral pain is a common problem of the knee. If you have this condition, you feel pain under and around your kneecap. The pain can get worse with activity or after sitting for a long time. You can have the pain in one or both knees.

The exact cause of patellofemoral pain isn't known. It probably has to do with the way your kneecap (patella) moves on the groove of your thigh bone (femur). Too much pronation is one cause of the knee cap not moving properly on the thigh bone.

Don’t let your knee pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office.

Medical Studies Supporting the Use of Foot Orthotics in Treatment of Knee Pain
1. Kerrigan DC, Arch Phys Med Rehabil. 2002 Jul;83(7):889-93. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis.

2. Marks R, Penton L Are foot orthotics efficacious for treating painful medial compartment knee osteoarthritis? A review of the literature. Int J Clin Pract. 2004 Jan;58(1):49-57.

3. Ogata K, Int Orthop. The effect of wedged insoles on the thrust of osteoarthritic knees. 1997;21(5):308-12.

4. Russel Rubin and Hylton B. Menz. Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis: A Preliminary Investigation. J Am Podiatr Med Assoc 2005 95: 347-352.

5. Johnston LB, Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2004 Aug;34(8):440-8.

6. Saxena A, Haddad JThe effect of foot orthoses on patellofemoral pain syndrome J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):264-71.

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All pages on this website © 2005-2013
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.

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