How and why your shoes can cause pain in your knee

Comfortable footwear plays a pivotal role in maintaining overall well-being, serving as a foundation for mobility and daily activities. Beyond mere fashion considerations, the shoes we choose can significantly impact our musculoskeletal health, particularly in the context of knee pain. The connection between footwear and knee discomfort is a critical aspect of understanding how our daily choices can affect our bodies. The knee joint, a complex hinge joint crucial for mobility, is susceptible to stress and strain caused by improper footwear. When shoes lack adequate support, fail to provide proper alignment, or are ill-fitting, the knees bear the brunt of these deficiencies, often leading to discomfort and pain. This connection underscores the necessity of exploring how the choices we make regarding our footwear can have far-reaching consequences for the health and functionality of one of our most vital joints.


Footwear and knee health

The impact of footwear on knee health is intricately tied to the provision of proper support for the feet. Feet, being the foundation of our body's weight-bearing structure, require adequate support to distribute the load evenly. Shoes that lack proper support can lead to an imbalance in weight distribution, placing undue stress on the knees. Moreover, the role of shoes extends beyond mere support; they play a crucial part in maintaining alignment and stability of the entire lower extremity. A well-designed shoe with appropriate arch support and cushioning helps in aligning the foot, ankle, and knee joints in a biomechanically efficient manner. This alignment is essential for preventing overpronation or supination, irregular movements that can lead to misalignment of the knee joint. Therefore, the importance of choosing footwear that offers both support for the feet and maintains proper alignment cannot be overstated, as it directly contributes to the overall health and longevity of the knee joints.


Types of shoes that can cause knee pain

Generally speaking, your shoe choice is more important than you might think! Certain types of shoes have been identified as potential culprits in causing knee pain, with each posing distinct challenges to knee health. High heels, for instance, significantly impact knee alignment. The elevation of high-heeled shoes alters the natural angle of the foot due to the heel height and heel lift itself, causing the knees to bend forward, which can lead to increased pressure on the joint and potential misalignment. Improperly fitting shoes are another culprit, as shoes that are too tight or too loose can result in uneven distribution of weight on the feet, consequently placing strain on the knee joints. Moreover, a lack of proper arch support can contribute to knee pain by affecting the natural arch of the foot. Flat shoes without sufficient arch support fail to absorb shock effectively, causing increased stress on the knees during walking or other weight-bearing activities. Understanding the adverse effects of high heels, ill-fitting shoes, and inadequate arch support is crucial for individuals seeking to make informed choices about their footwear and prioritize the long-term health of their knees. It is important to wear the right shoe for what you are doing at the time. For example, wearing more athletic shoes or trainers with the correct type of support are the best shoes for sports or exercise. Wearing the wrong shoes or unsuitable footwear for activities may not only lead to foot pain but can alter the way your walk or run and lead to knee problems as a consequence. It's probably not wise to wear flip flops for a 10k run!


Footwear when running

The importance of footwear in the context of running cannot be overstated, as the right shoes play a pivotal role in enhancing performance, preventing injuries, and ensuring overall comfort. If you suffer from knee, ankle or even hip pain, it might be worth speaking to a running expert or even a physical therapist to get some advice on some proper footwear and what kind of trainers might be a good option for your specific needs. Running involves repetitive and high-impact movements, placing extra pressure on the feet and joints. Proper running shoes are designed to provide the necessary support and cushioning to absorb shock, reducing the impact on the lower extremities. The right pair of running shoes helps maintain proper biomechanics, promoting a natural and efficient gait cycle. Additionally, adequate arch support and stability features contribute to preventing overpronation or supination, reducing the risk of injuries such as shin splints, stress fractures, and plantar fasciitis. Furthermore, the choice of footwear can significantly impact running efficiency, enabling runners to optimize their stride and energy transfer. In essence, investing in appropriate running shoes tailored to individual biomechanics and preferences is a fundamental step towards a safer, more enjoyable, and effective running experience. Running shoes also wear down over time. So even if you did buy a good pair of shoes a long time ago, or you are an avid runner who racks up a lot of miles in each week... it might be time for some new shoes as the sole of your shoe can wear down as you pound the pavement and they might not be able to absorb the force from your body weight as well over time. As a general rule, you should look at upgrading or replacing your running trainers every 500 miles.


What injuries can be caused by wearing incorrect footwear?

Wearing incorrect footwear can give rise to a spectrum of injuries that extend beyond mere discomfort to potentially debilitating conditions affecting various parts of the body. Knee and ankle joint pain are the most common when it comes to footwear-related "injuries" but there are several than can be caused as a knock on effect. One prevalent issue is the development of bunions, a painful deformity of the joint at the base of the big toe, often exacerbated by ill-fitting or narrow shoes. Likewise, conditions like corns and calluses can emerge due to excessive friction and pressure from shoes that do not accommodate the natural contours of the feet. Inadequate arch support may contribute to plantar fasciitis, causing intense heel pain, while wearing high heels regularly can lead to Achilles tendonitis, impacting the tendon's flexibility and causing discomfort. The misalignment induced by improper footwear can also extend to the knees and hips, resulting in overuse injuries, such as patellofemoral pain syndrome (runner's knee) or iliotibial band syndrome. Furthermore, stress fractures and shin splints can manifest when shoes fail to absorb or distribute impact forces effectively during activities like running. The cumulative effect of wearing incorrect footwear underscores the importance of mindful choices to mitigate the risk of a myriad of injuries that can compromise not only foot health but overall musculoskeletal well-being.


The biomechanics of walking

The biomechanics of walking are intricately tied to the types of shoes we choose to wear, as different footwear can significantly influence walking mechanics. The natural gait cycle involves a complex interplay of movements, and shoes play a crucial role in either supporting or disrupting this process. For instance, the way shoes affect pronation and supination—the natural rolling of the foot during each step—can have a profound impact on knee alignment. Pronation occurs when the foot rolls inward, while supination involves an outward roll. Both these movements, when excessive or insufficient, can lead to misalignment of the knee joint. Shoes with inadequate support may contribute to overpronation or supination, placing undue stress on the knees and potentially causing discomfort or pain. Specific purpose-made types of footwear such as walking shoes can provide extra cushioning for activities like hiking which typically involve repeated movement over time which can but a lot of stress on your ankles, knees and the muscles of your lower leg specifically. Understanding how different types of shoes influence these biomechanics is essential for individuals aiming to make informed choices to promote optimal walking mechanics and preserve the health of their knees.


Choosing the Right Shoes for Healthy Knees

Selecting the right shoes is a crucial step towards maintaining healthy knees, and several key considerations come into play. Firstly, the importance of proper fit and sizing cannot be overstated. Shoes that are too tight or too loose can disrupt the natural biomechanics of the foot and, consequently, impact knee alignment. Ensuring that shoes provide a snug yet comfortable fit is fundamental to preventing unnecessary stress on the knees. Additionally, opting for footwear with adequate arch support is pivotal. The arches of the feet act as shock absorbers, and shoes that offer proper support contribute to maintaining the natural arch shape, preventing overpronation or supination that may lead to knee misalignment. Lastly, considering the type of activity and shoe design is essential. Different activities place varying demands on the feet and knees, and choosing shoes designed for specific activities, coupled with appropriate features, ensures that the footwear complements the body's movements, promoting healthy knee function. Ultimately, an informed approach to selecting shoes involves a holistic consideration of fit, support, and design to safeguard the well-being of our knees.


Tips for Alleviating Knee Pain through Footwear

Effectively alleviating knee pain through footwear involves adopting a proactive and informed approach. One practical tip is to incorporate orthopedic inserts into your shoes, providing additional support and cushioning. These inserts can help address issues such as flat feet or inadequate arch support, promoting proper alignment and reducing strain on the knees. Regularly assessing and replacing worn-out shoes is another essential strategy. As shoes age, their supportive features diminish, potentially contributing to improper weight distribution and increased stress on the knees. Being vigilant about the condition of your footwear and replacing them when necessary is a simple yet effective way to prevent or alleviate knee pain. Moreover, seeking personalized advice from a healthcare professional is invaluable. Consulting with a podiatrist or orthopedic specialist can offer insights into your specific biomechanics and foot structure, leading to tailored recommendations for footwear choices that best suit your needs and alleviate knee pain. By combining these tips, individuals can take proactive steps to enhance the support provided by their footwear, promoting knee health and overall well-being.


In conclusion, the impact of footwear on knee health is a multifaceted relationship that cannot be overlooked. As we've explored the intricate dynamics between various types of shoes and knee discomfort, it becomes clear that our choices extend beyond style considerations—they directly influence the biomechanics and alignment of our knees and their associated shock absorption. From the potential pitfalls of high heels to the consequences of ill-fitting shoes and the significance of adequate arch support, the importance of making informed footwear choices emerges as a central theme. This exploration reinforces the critical role of proper shoes in preventing knee pain and maintaining optimal joint function. As a takeaway, there's an encouraging call to action for individuals to be proactive in avoiding wearing the wrong type of shoes. By prioritizing proper fit, support, and considering the demands of different activities, one can significantly reduce the risk of knee pain and contribute to overall musculoskeletal well-being. Informed choices in footwear serve as a preventative measure, empowering individuals to stride confidently towards a future where knee health is prioritized and pain minimized.

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Arun Gray sports therapist strength and conditioning coach skegness

The author

Arun Gray is a sports therapist and strength & conditioning coach with over 15 years experience in the industry. He also has a personal history with chronic shoulder and back pain along with a range of other sporting injuries.

Arun writes about common injuries and aims to help people understand and manage their pain to prevent having to rely on national healthcare.

Read more about Arun