Some shoes are designed to look good, while others are designed for foot support and comfort. In addition to affecting your feet, however, footwear also affects the positioning of the rest of your leg and could potentially provoke knee pain. The knee is a hinge joint formed by the thighbone, or femur, and the large bone in your lower leg called the tibia. Structures called menisci provide padding between these bones and act as shock absorbers. Several ligaments also support the knee joints. When the knee is properly aligned, pressure is distributed evenly throughout these supporting structures. However, when these bones are no longer stacked directly on top of each other, some structures are stressed more than others. Shoes alter the position of your feet, which in turn can affect the way your knee joints are positioned -- for better or worse.
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High heels may dress up your wardrobe, but they could be making your knees hurt. According to a study published in March 2015 in the "Journal of Orthopaedic Research," walking in high heels increases the distribution of weight and stress through the insides of your knee joints. The degree of knee stress increases along with the height of the heel. Wearing high heels also changes the position of the femur bone, placing more pressure on the front of the knee joints and potentially causing pain. The knee stress and pain could be decreased by wearing high heels that have a platform under the sole of the foot.
Muscles that cross the knee joint help keep it stable. In a standing position, your knee joint rotates slightly as it fully straightens. This movement locks the knee into place, decreasing the workload on the surrounding muscles. Wearing high heels interferes with this process, requiring the muscles around your knees to work harder. This could lead to tendinitis and pain in your knees.
There are many different types of athletic shoes. They can generally be categorized as stability shoes or minimalistic shoes. The main difference is the amount of support provided for your feet. Stability shoes tend to be more rigid, decreasing foot movement as you walk. Minimalistic shoes tend to be flatter and thinner, allowing your foot to move more naturally as you walk. This can help keep your knees properly aligned as you walk. According to a study published in July 2010 in "Arthritis Care and Research (Hoboken)," stability shoes increase the amount of pressure through the inside of the knee joints as you walk, potentially leading to knee pain.
Knee pain can also occur if you wear the wrong type of shoe for a particular activity. For example, many outdoor sports require the use of cleats -- shoes with studs on the soles -- to improve traction when planting your feet and changing directions quickly. Running shoes are specifically designed to improve movement in a forward direction. Wearing improper footwear for any of these activities can change the stress placed on your knee joints, possibly leading to injury and pain.
Clogs are popular everyday footwear, especially among people who stand a lot. Clogs are advertised as supportive shoes; however, the more rigid a shoe is, the less your feet can move naturally. When movement of your feet is limited, stresses placed on your knee joints increase. Similar to stability athletic shoes, clogs can potentially lead to knee pain due to increased stress on the inside of your knee joints.
Flip-flops often get a bad rap. However, flat shoes such as flip-flops are more flexible than many other types of shoes and allow your foot to move more naturally. According to the study published in July 2010 in "Arthritis Care and Research (Hoboken)," flip-flop flexibility led to decreased stress through the knee joints during walking when compared with stability shoes and shoes with a raised heel. Thin-soled shoes such as flip-flops also allow you to feel the ground better as you walk, helping your muscles to fire correctly. This may also decrease stress through your knee joints.
Proper footwear should be determined on an individual basis. For example, if you have high arches, you may need to wear stability shoes to correctly distribute stress through your knee joints. People with flat feet, however, may require a different type of footwear or shoe inserts to achieve proper foot and knee alignment.
Knee pain can be caused by many different factors, some much more serious than footwear. If you have knee pain, see a healthcare professional to determine the underlying cause and appropriate treatment.
Reviewed by: Tina M. St. John, M.D.
- Arthritis Care and Research (Hoboken): The Effects of Common Footwear on Joint Loading in Osteoarthritis of the Knee
- Journal of Orthopaedic Research: Effects of High Heel Wear and Increased Weight on the Knee during Walking
- PLoS One: Knee Adduction Moment and Medial Contact Force – Facts About Their Correlation During Gait
- The University at Buffalo: Knee Kinematics and Kinetics