Knee Pain & Footwear

Many healthcare providers spend the majority of their workday on their feet, running between patient call lights or performing long medical procedures. Thus, lower extremity pain is a real issue.

Did you know for people over the age of 50, knee pain causes more disability with daily activities (e.g., walking and stairs) than any other disease (Nigg and Emery, 2006)? With this limitation in activity, individuals develop risks for morbidity and mortality from modifiable diseases such as cardiovascular disease, diabetes, and obesity.

So what causes knee pain? Injury, TMB syndrome ("too many birthdays" – or to use a layperson's term, "age"), disease, and wear-and-tear from use are the most common causes. The biomechanics of the knee and lower extremity can also cause pain from the "bone to bone" interaction (Nigg and Hintzen, 2006). For example, excessive pronation, or flat foot posture, causes the femurs and tibias to rotate inwardly. This deviation from a more neutral position may increase stress on medial knee tissues and/or create iliotibial band syndrome over the lateral knee.

The posture and function of the foot and ankle play a significant role in knee pain. According to Donatelli's comprehensive work, The Biomechanics of the Foot and Ankle, the most commonly reported overuse-type injuries occurred at:

How do my shoes affect my knee pain?

The type of shoes change some of the "ground reaction forces" when walking or running. Shoes may allow or limit the motion at the foot/ankle, thus affecting the positions of the knees and hips. This causes the increase or decrease of stress on the medial and lateral aspects of the knee.

That being said, everyone's posture and biomechanics are different. Some individuals require a shoe with more stability and a higher arch – some may require a flexible, low-arch shoe. The bottom line is that comfortable shoes, such as Crocs, Birkenstock, or athletic shoes may decrease knee pain (Messier, 2002; Nigg and Hintzen, 2006). Whatever type of shoe improves the function of the entire lower extremity can also decrease knee pain. Test each new pair of shoes at home on hard surfaces and up and down the steps – typically, how you tolerate stairs is the true test of shoes!

Some people may require a slight modification (heel wedges) to limit over pronation. A recent study found that minimal correction did improve function, walking up and down steps, and decrease pain for individuals with medial compartment knee osteoarthritis (Fang, 2006). For more stubborn cases, custom orthotics may be indicated, but probably will not be covered by insurance. In physical therapy, it is not uncommon to make biomechanical corrections (in shoes) at the feet and ankles to treat problems such at patellofemoral syndrome and illiotibial band syndrome.

On the reverse side of the issue, Yeager, writing in the February 2007 issue of Prevention, cited a study from Rush Medical College, which found going without shoes relieved knee stress on participants with osteoarthritis!

But because you have to wear shoes to work – JCAHO expects it, and your colleagues will appreciate it – if you have knee pain, see your physical therapist or physician. A thorough assessment of your biomechanics and some footwear recommendations may just improve your 10- to 14-hour shift on your feet.

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