There is one conversation that comes up again and again in our clinic. Someone walks in with back or knee pain that has been there for months. They have tried stretching, changed their chair, seen their GP, and been told that “there is nothing seriously wrong for now”… and at some point they ask: could my feet have anything to do with this?
The answer, more often than not, is yes.
Not always. Not in every case. But with a frequency that still surprises us after more than twenty years, we find that the origin of pain a patient feels in their back, knee or hip has a great deal to do with how their foot lands with every single step they take.
This article is not here to convince you that all your pain comes from your feet. What we do want is to explain why that connection exists, which signs are worth looking into, and what a gait and podiatry assessment can offer when the pain simply refuses to go away with the usual approaches.
Your feet are the foundation, quite literally
Every time you walk, each step sets off a chain of movement that begins at the foot and travels up through the ankle, knee, hip, pelvis and spine. It all happens in fractions of a second, thousands of times a day, without you ever thinking about it.
That chain works well when every link does its job. But when the foot does not land in the most efficient way, the rest of the body has to compensate. And compensation, sustained over time, becomes overload.
What we see in clinic is that many people have spent years walking with a gait pattern that creates small, repeated stresses in the knee, hip or lower back.
It is not pain that appears suddenly after a fall; it is a slow, quiet accumulation that one day reaches a point where the body can no longer keep compensating without complaining.
A figure we often use to explain this: it is estimated that 90% of our overall posture is determined by how we stand and walk. Not a number designed to impress, just to help you understand how much weight your feet carry in shaping the rest of your body.
What happens in the chain when your gait is off
There is no single way to walk “badly”. There are several different biomechanical patterns, each generating overload in different areas. These are the ones we see most often in our clinic:
Overpronation: when the foot collapses inward
Pronation is a normal movement of the foot while walking, it is how the foot absorbs impact. The problem arises when that movement is excessive or poorly controlled.
A foot that overpronates tends to roll inward with each step. That forces the shin and knee into a rotation they are not designed for, which can lead to pain on the inner side of the knee, tendinopathies, or discomfort in the hip.
Further up the chain, that rotation throws off the alignment of the pelvis, and the lower back ends up working in a slightly forced position for hours on end. Over time, that hurts.
Supination: when the foot rolls outward
Supination is the opposite: the foot tends to land more on its outer edge, with poor cushioning and poor adaptation to the ground.
People with this pattern often have recurring ankle sprains, overload on the outer side of the knee, and in many cases pain along the iliotibial band, the strip of tissue running from the hip down to the knee along the outer thigh.
Other patterns that often go unnoticed
Beyond overpronation and supination, other situations also generate overload: flat feet (a low arch that does not absorb impact well), high-arched feet (rigid and lacking flexibility), leg length differences, or simply asymmetries in how weight is distributed that are not easy to detect with the naked eye.
All of them, over time and depending on how active a person is, can end up being the origin of pain that seemingly has nothing to do with the feet.
Signs your body has been sending you (that you may have ignored)
One of the first things we do when someone comes to us with back or knee pain is ask about their footwear. It is not a random question, your shoes are, quite literally, a record of how you walk.
Uneven wear on the sole is one of the clearest and most overlooked signs. If you pick up your everyday shoes and the sole is much more worn on one side than the other, or if the heel shows marked wear toward one edge, your gait is not symmetrical. That does not mean there is a serious problem — but it does mean it is worth looking into.
Other things patients tell us that point toward a biomechanical issue with the gait:
Pain at the end of the day in the lower back, knees or hips, especially after long periods standing or more walking than usual. A body that compensates well has resources; when those run out after hours on your feet, the pain appears.
A feeling of instability or a tendency to roll the ankle, even on flat ground. If your ankle “gives way” easily, something at the base is not working quite right.
Injuries that keep coming back. The runner who always ends up with the same inflamed knee. The person who has had plantar fasciitis for two years, it gets better and comes back. The tendinitis that never fully goes away. When an injury recurs time and again, we look at the gait pattern because that is where the answer often lies.
Calluses in specific areas of the sole, which are the body’s way of telling you there is excessive, repeated pressure at a particular point.
If you recognise two or more of these signs, it makes sense to book a gait and podiatry assessment before the problem becomes chronic.
Who is most at risk: people on their feet all day, active individuals and amateur athletes
While anyone can be affected by a gait pattern that causes overload, there are three profiles we see very frequently in clinic.
Workers who spend long hours on their feet
Hop assistants, waiters, nurses, teachers, hairdressers. These are people whose bodies accumulate eight to twelve hours of load on their feet every day, often on hard floors and in footwear that is not always the most suitable.
When there is any alteration in the gait pattern, that volume of hours means the body feels it sooner and more intensely.
Active people in their daily life
Walkers, hikers, people who exercise regularly without being competitive athletes. These are individuals in good physical shape who have often never had their gait assessed, and when discomfort appears they put it down to “overdoing it” when there is actually a biomechanical factor at play.
Amateur athletes, particularly runners. Running is perhaps the sport where the link between gait and injury is clearest. A runner covering forty kilometres a week is taking tens of thousands of steps with the same pattern.
If that pattern needs correcting, the body amplifies it in direct proportion to the training volume.
For all three profiles, working with a podiatry and biomechanics clinic is not just about treatment — the preventive value is enormous. Correcting a gait pattern before it causes a chronic injury is always more straightforward than treating one once it has taken hold.
What a podiatry and biomechanics clinic can assess
When someone comes to our clinic asking whether their feet could be connected to their back or knee pain, the assessment does not begin with technology — it begins with a conversation.
We want to understand your daily life: how many hours you spend on your feet, what footwear you normally use, whether you play sport and what kind, when the pain appeared and what makes it worse. With that context, the examination makes far more sense.
Then we move to the assessment itself. A biomechanical gait analysis looks at how the foot functions both in static (standing, bearing weight) and in dynamic conditions (walking, and running if relevant).
We look at the mechanical axes of the leg, knee and hip, the alignment of the pelvis, whether there are differences between one side and the other, and how the body distributes load when it lands.
All of that allows us to identify whether there is a pattern generating overload in specific areas, and from that information we can put together a concrete treatment plan.
That might mean guidance on the most suitable footwear, a programme of corrective exercises, prescription of custom insoles to redistribute load more efficiently, or a combination of all three.
What we do not do is prescribe insoles for everyone. They are not always the answer, and a poorly indicated insole can do more harm than good. The aim of the assessment is to understand your specific case, not to apply a one-size-fits-all solution.
Why combining podiatry and physiotherapy makes the difference
There is something we hold firmly at Fisio Physio Clinic Salinas: the foot does not work in isolation, and it should not be treated in isolation either.
When we find that the gait is causing overload in the knee or back, podiatry addresses one part of the problem: correcting the loading pattern. But the other part, the muscles that have been under tension for months, the tissues that have adapted to a compensatory posture, the movement patterns the body has learned in order to live with that imbalance, needs physiotherapy.
The combined approach is what allows us to get to the root cause rather than just the symptom. It is the difference between relieving pain for a few weeks and resolving the mechanism that was producing it.
In practice, this means the podiatrist and physiotherapist share information about your case, set objectives together and coordinate the treatment plan.
They are not two parallel consultations that never speak to each other, they are two perspectives on the same problem, working toward the same goal.
This integration is especially important in recurring sports injuries, in cases of chronic lower back pain with no clear structural cause, and in people who have been through many treatments without lasting improvement.
An assessment at a podiatry and biomechanics clinic supported by physiotherapy changes the outcome because it changes the question: not “where does it hurt?” but “why does it hurt, and what is keeping it that way?”
Prevention over treatment: the approach that pays off most
One of the things we find most valuable about addressing gait in clinic is that it opens the door to prevention, not just treatment.
When someone arrives with pain that is already well established, the process is longer and more complex.
But when someone comes in for a preventive assessment, because they exercise regularly, because their job keeps them on their feet, because they have noticed some of the warning signs we have described, there is far more room to act.
A biomechanical gait assessment done at the right moment can prevent a small asymmetry from turning into plantar fasciitis, stop an uncorrected overpronating gait from leading to runner’s knee, or keep years of lumbar overload from progressing to a disc problem that limits quality of life for months.
This is not about over medicalising things or looking for problems that do not exist. It is about making informed decisions about your body before pain forces you to.
If you exercise regularly, if your work involves long hours on your feet, or if you have been living with vague discomfort in your back, hips or knees that nobody has properly explained, a review at a podiatry and biomechanics clinic is a sensible and genuinely useful step.
Does it make sense for us to assess you at Fisio Physio Clinic Salinas?
If you have read this far, something here has probably resonated: the uneven wear on a sole, the pain that always shows up at the end of a long day, the injury that never quite goes away, that feeling that your body cannot quite find its balance.
At Fisio Physio Clinic Salinas we can carry out that assessment with you. We start by listening to how your daily life looks, then we analyse how you walk and how load is distributed through your body, and we work out whether there is anything worth addressing, with what tools and with what realistic goals.
If combining podiatry and physiotherapy makes sense for your case, we coordinate that internally so the plan is coherent and you are not left bouncing between specialists who are not in contact with each other.
And if the assessment shows that your gait is fine and the source of your pain lies elsewhere, we will tell you that just as clearly. Being honest about what we can and cannot offer is part of how we work.
Sometimes a good biomechanical review is the first step toward understanding why something has been hurting for months without explanation. And that, in itself, is worth a great deal.