Knee PainThere are a variety of different types and causes of knee pain, and your treatment will vary depending on the cause. Treating knee painIf you are suffering from knee pain and you also have flat feet (over pronate), it may be worth seeing a podiatrist to assess whether you may benefit from orthotic therapy to control your pronation. Hip and lower back painThere are many and varied causes for hip and lower back pain and as with knee pain, the hip and lower back can also be affected by poor foot biomechanics, and over pronation in particular.
When the positioning of any joint or structure in the body is put out of it’s normal alignment it can result in pain, discomfort or injury. A study published in Arthritis Care and Research examined the relationship between flat feet, knee pain, and arthritis in people over 50. Pronation is the natural flattening of the arch that occurs with walking or running that serves as a natural form of shock absorbtion.

Overpronation (commonly termed flat feet) is an excessive rolling in of the ankle and collapsing of the arch when the foot is weight bearing.
In some cases, knee pain can be exacerbated by poor foot biomechanics, most commonly over pronation (flat feet).
Whilst you will likely need to seek trained advice from a therapist to assess and treat your hip or lower back pain, it is worth being aware that your foot biomechanics may be playing a part in your condition, and treating any abnormal biomechanics may assist in your recovery. The researchers concluded that having low arches is associated to frequent knee pain and cartilage damage on the inside of the knee in older adults.
The analyzed data showed that the flatter the arch was according to the SAI the more likely the individual was to have knee pain.
In other words, while it is possible overpronation may lead to knee pain and cartilage damage, it may also be just as likely that knee pain and arthritis result in a flat foot deformity as other studies have suggested.

Recent studies however have also found an association between flat feet and patellofemoral pain syndrome–a condition that usually affects adolescents and young adults. Collapsing of the arch produces excessive  rotation of the lower leg which can affect the alignment of the bones the make up the knee joint.
I think timing and magnitude of pronation might still be risk factors for problems at the knee, but I agree with you that this may well be a reflection of the hip’s mechanics.
That’s where environmental factors, like sitting 10 hours a day or constantly walking on hard, flat surfaces, have their effect.

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