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Can Knee Pain Be Caused by Overpronation of the Foot?

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By Babafemi Adebajo
Romi Hector
Edited by Romi Hector

Updated January 31, 2024.

Woman in sports tights bending over and clutching knee

The knee works together with the hip and ankle to transfer weight from the back and pelvis to the ground during walking or running. If there is pain, moving the knee becomes an inconvenience and can be uncomfortable. Interestingly, knee pain has a myriad of causes, some of which exist outside of the knee joint itself. One such cause is foot overpronation.

What Is Overpronation of the Foot?

Overpronation is the inward turn of the ankle and foot during heel strikes when you take a step. As a result, you push off with the big toe and second toe instead of the forefoot.

How Overpronation Might Cause Knee Pain

With each step, the foot continues to twist more, causing tibial rotation. At the same time, the upper leg is rotating in the opposite direction. The two opposing forces meet at the knee, leading to excessive strain on the knee joint. To compensate for the excessive force, the knee takes up a knock-kneed position. This leads to even more muscles exerting their force in an abnormal direction.

The internal rotation of the knees can cause the patella to pull in the wrong direction. The grinding of the patella over unusual areas can result in injury and pain, which is often felt when the knee is bent during activities like squatting, climbing stairs, sitting on a low stool, cycling, etc. This pain is known as patellofemoral pain syndrome.

Asides from this, the excessive foot pronation and upper leg rotation can also cause inflammation and irritation around the knee cap. The iliotibial band on the outside of the knee can easily become inflamed in such a situation, leading to iliotibial band pain syndrome. In such a case, pain is felt on the outside of the knee.

Also, the continuous push-off with the big and second toe while walking leads to foot instability, and unstable feet can easily cause falls and lead to a knee injury.

Knee pain can also be caused by knee arthritis. Read our post to learn more about relieving pain from knee arthritis.

Other Dangers of Overpronation

Overpronation can cause more than overpronation. There are several other possible complications. Some of them include:

  • Heel pain This is the pain that occurs behind, beneath, or in the heel bone.
  • Achilles tendinopathy Straining the Achilles tendon will result in irritation and inflammation.
  • Shin splints This overuse injury is caused by increased force transmitted through the lower leg.
  • Bunions This is a bony outgrowth on the outside of the big toe due to continuously bearing weight.
  • Stress fracture Stress fractures are caused by very small cracks in the weight-bearing bones of the feet and lower legs.
  • Low back pain Though the two might seem unrelated, overpronation can cause lower back pain.

How to Treat Knee Pain Caused by Overpronation

Knee pain caused by overpronation is susceptible to conservative treatment if initiated early. The earlier the intervention, the better the prognosis. These treatment methods include:

Activity Modification

Poor technique, form, or activity volume can exacerbate symptoms. For example, you might experience knee pain when squatting, so it may be necessary to modify this activity to manage knee pain.

RICE (Rest, Ice, Compression, and Elevation)

Like most acute injuries, the RICE method limits inflammation and relieves pain. Depending on the level of inflammation, it may be used in combination with non-steroidal anti-inflammatory drugs (NSAIDs).

Custom Orthotics

Custom orthotics are designed to support your foot arch and correct abnormal foot motions. They help reposition the foot, leg, and knee, reducing contrarian forces and improving stability. They also cushion the feet while maintaining flexibility.


A combination of stretching and strengthening exercises for the muscles of the lower limb and foot will help correct the alignment of the ankles and knees.

Taping and Bracing

These can also provide motion control, limiting abnormal movement of the lower leg and foot during movement.

Physical Therapy

A physiotherapist can help address pain from overpronation using TENS, ultrasound therapy, and several other methods. Also, they can retrain your gaits and recommend activity modification in such a way as to limit overpronation during foot motion.

Proper Footwear

Appropriate footwear is crucial if overpronation is to become a thing of the past. The best footwear for flat feet will have a firm heel counter, a wide support base, and a firm midsole. Usually, these kinds of footwear are labeled as stability shoes, insoles or motion control shoes. Some may also come with extra arch support to prevent flat feet or the flattening of the foot arch.


As with many other conditions, surgery is often considered a last resort when conservative treatment has failed to address or relieve symptoms after several weeks. Surgery will aim to correct any complications or deformity and relieve pain.

Take a look at our post to learn more about treating overpronated ankles.