Knee Pain: Fixing the Foot – Part 2

By djpope

April 12, 2012

foot, injury prevention, Knee, pain free

Alright, so now we know why the hip and foot are important in the health of our knees, let’s get into the nitty gritty of how to address these problems.

Part 1Part 3Part 4

Taking a look at the video below we can see that in some athletes, the knees really sink inward into a genu valgus position during athletic movements like jumping and landing.

It happens when doing single leg exercises as well.

Finally, it happens notoriously at the bottom position of squats toward the end of the set and in other double leg exercises like deadlifting.

Now this can be coming from 2 areas:

  1. A weakness in the hips, core or weakness/poor positioning of the foot
  2. A flexibility deficit in the ankle or hips

How can we tell the difference?  If an athlete can get into a rock bottom squat and can land/lunge/move with good technique when they are fresh and using light weights, then their flexibility is fine.  These athletes typically have their knees fall inward when they’re at the end of a set or are challenged by something like a max effort lift or landing from a box that is too high for them.

If the athlete can’t get into a good deep squat on the first repetition and it can’t be corrected with cueing then its most likely a flexibility issue.  If the athlete has their knees come in on most very light non-strenuous exercises and plyometric activity then its most likely a flexibility problem.  You might have to assess their flexibility and take a deeper look into where the problem lies.  They might just have a combination of both.

If it’s a flexibility problem then stretching the hips and ankles is a great idea, but that’s an article for another day.  I want to focus on hip and foot strengthening.

Let’s start off with the foot first.  We’ve all heard about barefoot running and its theoretical benefits.  Supposedly landing on the forefoot instead of the heel places less shock and force on the foot and lends itself to less foot injury.  Also the barefoot shoe supposedly puts us into a better posture and can affect all of the joints above the foot, putting us into a better posture.  This has started a movement of doing dynamic warmups and such with your shoes off to strengthen the foot.  This is all well and good but just because you take your shoes off doesn’t mean that your foot will automatically get into the right position.  We’ve spent years training in shoes and our feet don’t know what position they are supposed to be in.  For example:

If you’ve got flat feet and you take your shoes off, you will probably assume an even flatter foot position because you don’t have the arch support from the shoes that you normally have.  If we ask our body to do challenging warm-up drills our feet will most likely stay flat and the flat foot position is being reinforced.

How about the athlete with a high arch.  Once their shoes are off they will probably be getting a lot of stress along the bottom of the foot(plantar fascia) because they’ve removed their shoes and don’t have the arch support they have normally.  If they aren’t taught how to support their arch  on their own they may be setting themselves up for foot injury because they’ve never had to support their own arch before.  They’re always had support from the shoe.  Both athletes need to learn about proper foot posture.

We fix this problem by reinforcing good foot position just like you would for technique of any other movement like squatting, running, jumping, changing direction etc.  We do this by learning the short foot posture popularized by Vladimir Janda.  Check out the video below I made for an explanation.

Now at first it’s going to be tough to learn just how to assume this short foot position.  Its best to start seated to get the feel of it.  Remember that we’ve spent an entire lifespan holding our feet in a particular position.  If we have to break this habit and put our feet into a better position(short foot) its going to take some devoted time and effort.

Once you’ve mastered the short foot posture sitting and then standing you can move onto more challenging exercises like squats, lunges and single leg balance drills.  I’m a big fan of single leg balance drills because you train the foot in a functional position as well as strengthen the hip simultaneously.  Check out this video I made below for an explanation:

Once you know the short foot posture and you’ve worked into reinforcing that position while moving you can now safely do barefoot warmups and help to strengthen the foot properly.  Just remember to progress slowly and stop when you can’t hold the posture any longer, just like you would if your technique broke down in any other lift.

Now that our feet are in a good position our knees are too.  This will decrease the forces on our knee that we get from a knee in or genu valgus position.  In part 3 of this series we’ll talk about the importance of the hip in knee health and specific exercises to address any problems.

Yours in good health,

Dan Pope

P.S. Remember this information is not to be used for the diagnosis or treatment of  knee problems.  Consult a professional if you are concerned you may have some type of knee injury.

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Page P, Frank C, Lardner R, (2010) Assessment and Treatment of Muscle Imbalance  Human Kinetics Chicago, Illinois