Walking, Foot Pain, and Why Real Change Takes Time

Understanding foot, knee, and gait mechanics as one system

Many people come to The Body Lab frustrated.

They’ve tried insoles, exercises, stretching, physio, massage — sometimes all of it — and yet their foot pain, knee pain, or walking discomfort keeps coming back.

What’s usually missing isn’t effort.

It’s understanding how the entire lower limb system works together during walking (Neumann, 2017).

This page explains:

• Why foot pain rarely starts in the foot

• How knee, hip, and gait mechanics are linked

• Why short-term relief doesn’t always last

• What actually needs to change for walking to improve long-term

Walking Is a System, Not a Single-Joint Problem

Walking isn’t controlled by one muscle or one joint.

It relies on:

• Dozens of joints

• Coordinated movement between the foot, ankle, knee, hip, and pelvis

• Precise timing controlled by the nervous system

Each foot alone contains 33 joints (StatPearls, 2024).

When you include the ankle, tibiofibular joints, knee (tibiofemoral and patellofemoral articulations), and hip, each lower limb contains close to 39 joints (Moore, Dalley and Agur, 2023; Standring, 2021).

Across both legs, this amounts to approximately 78 joints contributing to walking.

When even a small number of these joints stop moving or loading properly, other joints are forced to compensate — often leading to pain elsewhere in the system (Neumann, 2017).

Why Foot Pain Keeps Coming Back

Foot pain is often treated as a local issue:

• Tight calves

• Weak arches

• Plantar fascia irritation

• “Flat” or “collapsed” feet

But the foot does not work in isolation.

If ankle rotation is limited, load shifts upward.

If hip contribution is reduced, the foot stiffens to create stability.

If knee mechanics are altered, force distribution through the foot changes.

This is why foot pain frequently returns after treatment — the overall movement pattern has not changed (Neumann, 2017; Standring, 2021).

Pain relief without movement change is usually temporary.

How the Knee Fits Into the Picture

The knee sits between two rotating systems:

• The foot and ankle below

• The hip and pelvis above

Its primary role is force transfer, not force absorption (Neumann, 2017).

When movement above or below the knee is restricted, the knee often becomes:

• Painful

• Stiff

• Overloaded

• Unreliable during walking or running

This explains why knee pain is commonly associated with:

• Reduced foot pronation or supination

• Limited ankle rotation

• Poor hip control during stance phase

The knee is rarely the original problem — it is often the messenger (Standring, 2021).

Gait: Where Everything Comes Together

Gait is simply what happens when all joints are required to cooperate under load.

Each step involves:

• Heel contact and controlled loading

• Foot adaptation to the ground

• Ankle rotation

• Knee flexion, rotation, and extension

• Hip and pelvic contribution for propulsion and direction

When this sequence breaks down, the body compensates — often quietly at first (Neumann, 2017).

Over time, this compensation can present as:

• Recurrent pain

• Fatigue

• Reduced confidence in walking

• A feeling of asymmetry or instability

Why Improvement Can Happen Quickly — But Not Finish Quickly

Many people feel better after a session.

That improvement is real.

Early changes are largely driven by neural adaptation — improved coordination, timing, and motor control — rather than immediate structural change (Enoka, 1988; Carroll, Riek and Carson, 2001).

However, feeling better is not the same as being rebuilt.

Biological adaptation follows predictable timelines:

• Muscle strength and architecture: ~4–6 weeks (Blazevich et al., 2007; Folland and Williams, 2007)

• Tendon and ligament adaptation: typically 8–12+ weeks, often longer (Kjaer et al., 2009; Bohm, Mersmann and Arampatzis, 2015)

This difference explains why early improvements may fade if movement patterns are not reinforced over time.

Why Tendons and Ligaments Take Longer

Muscle adapts relatively quickly.

Tendons and ligaments do not.

Connective tissue:

• Responds more slowly to load

• Requires consistency rather than intensity

• Undergoes prolonged remodelling phases

Research consistently shows tendon stiffness and collagen remodelling require months rather than weeks, particularly when movement patterns are changing (Magnusson et al., 2007; Kjaer et al., 2009).

This slower adaptation is protective — it prevents tissue failure under load (Benjamin and McGonagle, 2001).

What Actually Needs to Change for Walking to Improve

For walking to improve long-term, the body needs:

• Joints that can articulate

• A nervous system that trusts the new movement pattern

• Muscles that support the sequence

• Connective tissue that can tolerate repeated load

This process does not happen in one session — even if pain improves quickly.

When you consider you are asking around 78 joints to cooperate differently, the required timeframe becomes logical rather than frustrating.

The Big Picture

This work is not about quick fixes.

It is about:

• Restoring joint movement

• Rebuilding coordination

• Allowing strength to develop

• Giving connective tissue the time it needs to adapt

When that happens, walking becomes easier, more efficient, and more reliable — and changes are far more likely to last.

References 

Benjamin, M. and McGonagle, D. (2001) ‘The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites’, Journal of Anatomy, 199(5), pp. 503–526.

Blazevich, A.J., Cannavan, D., Coleman, D.R. and Horne, S. (2007) ‘Influence of resistance training on human muscle architecture’, Journal of Applied Physiology, 103(5), pp. 1565–1575.

Bohm, S., Mersmann, F. and Arampatzis, A. (2015) ‘Human tendon adaptation in response to mechanical loading’, Sports Medicine, 45(11), pp. 1575–1595.

Carroll, T.J., Riek, S. and Carson, R.G. (2001) ‘Neural adaptations to resistance training’, Sports Medicine, 31(12), pp. 829–840.

Enoka, R.M. (1988) ‘Muscle strength and its development’, Sports Medicine, 6(3), pp. 146–168.

Folland, J.P. and Williams, A.G. (2007) ‘Morphological and neurological contributions to increased strength’, Sports Medicine, 37(2), pp. 145–168.

Kjaer, M., Langberg, H., Heinemeier, K., Bayer, M.L., Hansen, M., Holm, L. and Magnusson, S.P. (2009) ‘From mechanical loading to collagen synthesis in human tendon’, Scandinavian Journal of Medicine & Science in Sports, 19(4), pp. 500–510.

Magnusson, S.P., Hansen, M., Langberg, H., Miller, B. and Kjaer, M. (2007) ‘The adaptability of tendon to loading’, Journal of Applied Physiology, 102(6), pp. 2057–2063.

Moore, K.L., Dalley, A.F. and Agur, A.M.R. (2023) Clinically Oriented Anatomy. 9th edn. Philadelphia: Wolters Kluwer.

Neumann, D.A. (2017) Kinesiology of the Musculoskeletal System. 3rd edn. St. Louis: Elsevier.

Standring, S. (2021) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd edn. London: Elsevier.

StatPearls (2024) ‘Anatomy, Foot’, NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/