Foot First: The Key to Eliminating Knee and Hip Pain

The human body is a complex, interconnected system, where even small weaknesses in one area can have a cascading effect on the rest of the body. A prime example of this is the relationship between the foot, ankle, knee, and hip. Problems in the foot, such as weak foot muscles, poor ankle stability, or restricted mobility, can manifest as pain and dysfunction in the knee and hip. Understanding how foot strength and ankle stability are integral to knee and hip health is crucial for both prevention and treatment of common musculoskeletal conditions.

The Role of the Foot in Knee and Hip Pain

Your foot is the foundation of your body. It’s your primary point of contact with the ground, and how your foot interacts with the ground affects the mechanics of your entire lower body. If the foundation is unstable, it can lead to compensations further up the chain—often causing knee and hip pain. 

• Weak Feet and Lack of Ankle Mobility: Weakness in the intrinsic foot muscles or poor ankle mobility can disrupt the alignment and movement patterns of the leg. If the foot is not functioning optimally, it can alter how force is distributed through the leg, placing excessive stress on the knee and hip joints.
• Midfoot Instability: When the midfoot lacks stability or mobility, it affects how you absorb and transfer force during walking, running, or any weight-bearing activity. This leads to compensations, where other parts of the body—like the knees or hips—work harder to stabilise or move inefficiently. If your foot does not, absorb force correctly due to a lack of midfoot mobility, this can even lead to stress fractures of the foot.

Common Conditions Linked to Foot Weakness and Ankle Instability

1. Knee Pain (Patellar Tendinopathy, Patellofemoral Pain):
   • If the foot lacks proper support or the ankle is unstable, it can cause misalignment in the knee. For example, overpronation (when the foot rolls inward excessively) can lead to increased stress on the patellar tendon and the patellofemoral joint. Over time, this contributes to conditions like patellar tendinopathy or patellofemoral pain syndrome (PFPS).
2. Hip Impingement and Gluteal Tendinopathies:
   • A lack of stability in the foot forces the hips to compensate. If the foot doesn’t provide a stable base, the hip muscles, particularly the glutes, must work overtime. This can lead to injuries like gluteal tendinopathy or hip impingement, where the hip joint becomes stiff and painful due to restricted movement and poor joint mechanics.
3. Achilles Tendinopathy:
   • When foot strength is compromised, the Achilles tendon may bear additional load, especially during dynamic activities like running or jumping. Weak foot muscles and limited ankle dorsiflexion (the ability to flex the foot upwards) increase strain on the Achilles tendon, leading to tendinopathy.

Investigating the Hip in Knee Pain

It’s important to note that while foot mechanics are crucial, the hip also plays a significant role in knee pain. The hip controls the rotational movements of the leg and influences how forces are transmitted to the knee. For instance, weak hip muscles (like the gluteus medius) can cause inward collapsing of the knee, which is a common contributor to knee pain. Therefore, both the foot and hip should be assessed and addressed in any rehabilitation program aimed at knee pain.

However, even if there is an issue at the hip, it is important not to neglect the foot. Fixing the hip will require optimising how the foot interacts with the ground because the foundation is where stability and movement begin. If the foot is weak or unstable, it will be challenging to correct movement patterns at the hip.

Strengthening the Foot and Ankle

The good news is that strengthening the foot and ankle can significantly improve the health of your knees and hips. Developing strength, mobility, and stability in the foot and ankle enhances your body’s foundation, allowing better alignment and movement throughout the chain. Here are some key exercises to incorporate into your routine:

1. Single Leg Balance with Dumbbell Swing:
   • This exercise challenges both foot strength and ankle stability while also engaging the hips. Stand on one leg and hold a dumbbell in the opposite hand. As you balance, swing the dumbbell in front of your body and then behind you. This dynamic movement requires your foot and ankle to stabilise while your hips remain engaged.
2. Calf Raises:
   • Calf raises strengthen the muscles around the ankle, improving stability. Stand with your feet hip-width apart and slowly raise your heels off the ground, coming up onto the balls of your feet. Hold for a moment before lowering back down. For added challenge, perform this on one leg to target ankle stability.
3. Shortfoot Exercise:
   • This simple but effective exercise strengthens the intrinsic muscles of the foot. Sit or stand with your foot flat on the ground. Without curling your toes, try to “shorten” your foot by drawing the ball of the foot closer to the heel, engaging the arch. Hold this position for several seconds before relaxing. Repeat for multiple reps.

Foot and ankle strength and mobility play a crucial role in preventing knee and hip pain. A weak or unstable foot can lead to dysfunction throughout the lower body, causing conditions like patellar tendinopathy, patellofemoral pain, hip impingement, and Achilles tendinopathy. Strengthening the foot and ankle not only improves the foundation for movement but also reduces the risk of injury and compensations higher up the chain. Remember, the health of your knees and hips begins at the ground, so don’t neglect your feet!

(Published Mar 12, 2025)

Written By: Anouska Scarfe (Senior Physiotherapist)