Knee pain doesn’t always start at the knee. For one of our recent patients, an active hiker, the root cause turned out to be sitting much further down the kinetic chain- in the feet. This case is a great example of why a thorough foot plate analysis can be the missing piece in solving pain that seems, at first glance, to have nothing to do with the feet at all.
The Presenting Problem
Our patient leads a very active lifestyle, taking part in cycling, climbing or hiking weekly. Despite all that fitness, they’d started noticing knee pain particularly on a hike, when descending, whether on steep trails or stairs.
A few other details stood out during the initial assessment. The patient had a known difference in foot size between sides. On top of that, there was an old lateral ankle sprain, the kind of ‘minor’ old injury that’s very easy to forget about, but that the body often doesn’t.
What the Assessment Found
On examination, a few clear patterns emerged after completing postural observation, range of motion testing and strength testing. They revealed postural differences, muscle weakness, muscle over-activity and compensatory patterns in both feet. This was suggestive of a foot that was rigid and unable to dissipate load properly, which would indeed pass unwanted force up into the knee.
Put together, this painted a picture of an asymmetrical foot structure. Specifically, a genuine leg length difference, a supinated foot posture on both sides and reduced strength/ mobility through the forefoot of the affected leg. All of which can quietly alter loading patterns up through the ankle, knee and hip, particularly during high-demand movements like descending a steep hill under body weight and momentum.
The Plan: Foot Plate Analysis and PHITS Orthotics
A full foot plate analysis is able to map out pressure distribution, arch behaviour, and asymmetry in far more detail than visual assessment alone can offer. Based on the findings from initial assessment a foot plate analysis was definitely warranted. This was completed and the patient was fitted with custom PHITS orthotics, incorporating a leg length correction to address the asymmetries and included support tailored to the specific patterns identified on the foot plate.
This isn’t a one-size-fits-all insole. PHITS orthotics are built from the individual’s own foot plate data, meaning the correction is matched precisely to the patient’s loading imbalances. In this case the unabsorbed forces driving strain up into the knee on descents were identified and addressed.
Why This Matters
This case is a useful reminder that knee pain during a specific movement — like downhill walking — is often a symptom of a mechanical issue elsewhere. A leg length difference of over a centimetre, combined with reduced power and mobility in the toes and a supinated foot posture, creates exactly the kind of uneven loading that shows up more under load and impact, such as during sports or descending stairs.
By getting objective foot plate data rather than guesswork and building orthotics around the individual’s actual biomechanics, treatment can address the underlying cause rather than just easing the symptom. Getting the foundation right matters — quite literally, from the ground up.
