Do Flat Feet Cause Bad Knees?

This article would have you think so.

I was initially drawn to the story by the breathless tease on the top:

Having flat feet can destroy your knees: Many think wonky feet are a joke -- but the effects are often crippling.

Granted, this isn’t the New England Journal of Medicine. It’s Britain’s Daily Mail. Still, I was curious how flat feet could destroy a pair of perfectly good knees.

The story is that of Arti Godkhindi, 34, who describes her knees as “chronically bad.” The 5-foot-7-inch IT consultant weighed about 10 stone (140 lbs.) and got pregnant and gained two stone (28 lbs.) -- or 20 percent of her original weight. (For me, that would be like going from 175 lbs. to 210!)

During her pregnancy, she walked an hour a day to stay fit. After her daughter was born, she had trouble shedding her excess weight, so she joined a gym. “I started gently,” she says, then adds, “But as soon as I tried to do any running or stretching, I felt this excruciating pain on the inside of both knees.”

So she had an MRI done, which showed tears in the meniscus (pads of cartilage in the joint that absorb shock) in both knees. She was diagnosed with patellofemoral pain syndrome (which is pretty much a worthless diagnosis, I found: see here).

What’s the cause of her “permanent, disabling knee pain,” according to this article?

Her flat feet! Because, we are told, people like her (the quotes are from her doctor):

“... may have been living with faults in the way they walk, such as overpronation — also known as flat feet (which cause the feet to roll inwards) — or supination, where the feet roll outwards. They manage perfectly well until there is weight gain.”

Flat feet or other faults cause you to carry your weight through the wrong part of the foot, he [Dr. David Jones] explains, setting off a chain reaction upwards through the body.

“Where the knee cap connects with the thigh bone or femur, there is a V-shape groove, to help the knee cap glide up and down.

“If your feet roll inwards, the knee cap doesn’t move smoothly through this groove. We call this bad tracking and, over time, it leads to damage of the cartilage and pain.”

This is a conventional, structuralist sort of explanation for knee pain. However, as I’ve noted before, maltracking kneecaps may not be a significant predictor of knee pain (according to this study). And orthotics (which are recommended for flat feet sufferers later in the article), may be useless anyway, according to the New York Times ("The idea that they are supposed to correct mechanical-alignment problems does not hold up").

(Note: It is a good idea, of course, to wear proper-fitting shoes with good cushioning; that's common sense.) 

So, if I’m Arti’s flat feet, I’d start looking for a good defense attorney. After all, her Dad also has flat feet -- but no knee pain. What else may have caused her knee pain?

She gained a lot of weight during her pregnancy. Weight gain should always be a suspect in a knee pain whodunnit, whether you have flat feet or perfect arches.

Changes to her body during pregnancy (softening of muscles and ligaments, altering biomechanics, e.g.), as mentioned in the article, may have predisposed her to knee pain.

Her efforts to lose weight after the pregnancy should be strongly considered as possible culprits. Did she go from being fairly inactive to suddenly active? It wouldn’t need to take much either -- notice how a reference to running (“As soon as I tried to do any running or stretching, I felt this excruciating pain ...”) is quietly slipped into a quote.

But that’s huge! Running can be very hard on joints, especially if you’ve never done it before or are resuming the activity after a long layoff.

I’m not saying her flat feet are necessarily totally blameless. But I suspect their role in this misfortune has been much overstated.