flat feet and knock knees

My 11yo daughter has flat feet and knock knees. She catches in softball and plays forward and midfield in soccer. She’s being fitted for orthotics and wears the patellar knee stabilizers and otc shoe inserts currently. I’ve got her doing ankling along with stretching and strengthening her posterior chain to be able to get in a catcher’s position that will allow for less forward tracking of the knee. Can anyone give me other recommendations or good resources so that I can help her? Thanks

Thats kinda tough since she is pretty young my daughter is the same way. In a squat her knees move inward. I can lightly press her knees together and they cave in. I was going to have her do body wieght squats while pushing her knees out with rubber tubing around the knees. Another variation of this exercise is tubwalking. Walking side ways with rubber tubing around the knees and doing a squat with each side step.

If any one else has anything PIPE UP :slight_smile:

Have you already see Ato Boldon right feet ?

Whats wrong with Ato’s right foot?

Are the flat feet and knock knees causing any problems?

If not do not rush into anything just yet, let her develop and naturally. Has she grown alot recently? Could be a lack of strength due to rapid growth phase.

It´s more than 25º opened from center to right side,
and he still can be fast as he is.

Yes she’s having knee, ankle, and foot pain. She just started complaining about pain for about the past year. She just got orthotics today and was told by the team physician at Virginia Tech that she had “most impressively collapsed arch” that he had seen.


Something to look into. I use them and they are quality.

Could the flat feet be a combination of week muscles on the bottom of the feet and poor bone developement?? How’s here calcium intake? Does she ever go barefoot? Does wonders for building strong feet, especially in sand. The squats with tubing is a good idea, as are the “monster walks” with the tube. Also try alot of unilateral work, lunge walks, step-ups, bulgarian split squats, etc. It’s a self-correcting method. It’s really tough to let the knee drift in to center while you’re balancing on 1 leg. Works hip strength really well and the vastus medialis also. Good luck. I know this can be frustrating for a young athlete, but have her keep at it.


Thanks for all of the suggestions everyone.

Considering the impressive amount of pronation (flat-footed) seen in this female, I wouldn’t recommend this for her. I have studied this product (which has no real studies of success, by the way), and would only recommend it for individuals with mild cases of pronation and trying to strengthen the small muscles of the feet. Definitely orthotics are the way to go for this female, perhaps even an AFO (ankle-foot orthosis)

You might want to look at what is happening at the hip. If the External Rotators of the hip are weak this can allow for internal rotation of the femur, which can cause the “knock knees”. This can inturn cause the flat foot. Or it could just be the overpronation at the foot causing it all, but it is worth a look. I am in the process of doing a case study on one of my patients. Instead of typing the info all over again, I’ll give the link. It has pictures and descriptions of some exercises which can help if the internally rotated femur is the problem.


My posts start on the third page of this thread.

Great demonstration pictures. That jump seems pretty innovative. I believe these exercises could be helpful for my daughter’s problem but even if they’re not I’m sure that she’ll have fun attempting them. I’m sure these exercises will be helpful for my brother and father as they both have internal and external rotator issues. Thanks.

What he said, this is the most likely cause for all problems. Need to find a professional that understands the biomechanics and gets this corrected. This is a predisposition for ACL injuries in females. SPORTSMETRICS is a program the specifically works on this, more for jumping than speed develpment but does a good job a developing the ER of the hip as well as the functional chain. Any “good” personal trainer, physical therapist, or ATC should be able to help you.
Orthotics are a crutch in my opinion, they have their place, and with an eleven year old could assist in correcting the problem. The strength deficits as well as mechanics need to be addressed.

Can the femur internally rotate without the feet rotating as well? As I stand here experimenting with my own leg I see that it can if you externally rotate your ankles. Maybe that’s what she’s doing. The S & C that she has been doing has touched on about everything in the lower body except for rotation. This might be just what’s needed.

Interesting stuff. Did you notice in the after set of jumping pics his foot placement is significantly wider? It looks remarkably like his positioning in the overhead med ball tosses (to get the med ball between the legs the foot spacing must increase).

Next time he comes in try getting him to jump with his feet closer together. Video it and see if the internal rotation has changed with this foot spacing as well. It might just be that the wider foot spacing allows him to use his glutes more. In my experience the wider the feet the harder it is to let your knees move medially.

Keep us updated! This is good stuff.

After I took the pictures I had him redo the jump with his feet closer and it looked the same as with the feet wider. I just didn’t download the pictures on the computer because I didn’t have it with me and there was no difference.
I am planning on having him come in a late next week to video this again. It has been ~ 5-6 weeks since he was discharged and I want to see if the changes we made have stuck. They should have because he is currently doing the med ball throws, jumps, and vector reaches as a home exercise program. I’ll let you guys know what things look like.

Yes it can. Often individuals with internally rotated femurs often have their feet rotated laterally to compensate for the IR of the femur. This causes a lot of stress/strain on the knee medially and provide compression to the laterally knee.
The stress on the medial knee can cause patella-femoral tracking issues with the patella tracking more laterally because its angle of pull from the quads to the attachment at the tibial tuberosity has changed.
The compression forces on the lateral knee can cause a compartment syndrome like effect on the lateral knee area. It also shortens many of the muscles on the lateral side of the upper and lower leg. An example is the peroneus brevis and longus. They are shortened with this “knock knee” posture, and are also usually hypertonic and over active. In turn, the muscles on the medial leg are often hypotonic and inhibited. You can see the problem with this when you consider the peroneus longus and brevis have 2 major functions, eversion and assisting in plantar flexion. If they are shortened and overactive, both the posterior and anterior tibialis muscles will be lengthened and inhibited from performing one of their main functions, inversion. This can lead to the over pronation at the ankle, i.e. the appearance of flat feet.
It can be difficult to determine what is the true cause, however the good news is that many of the exercises that I described on the other site work to help to directly or indirectly strengthen both the external rotators of the hip and the muscles which aid in supination or eversion of the ankle/foot.

You really should look at Eric Cressey’s and Eric Robertson’s article series they wrote entitled Neanderthal No More. It is very good at breaking things down and shows gives specific exercises for different postural problems, not just hip/knee/ankle.

I’ll be looking at the Neanderthal series again. Sjake 77, what does the sportmetrics system consist of?

Basically jumping, it was developed by a well known PT (Kevin Wilk), nothing special though.

Here is an example of what most of the activities consist of.

Dynamic warm-up:
Heel/toe walk
Straight leg march
Hand Walk
Forward Lunge
Backward Lunge
leg cradle walk
Dog and Bush walk

Wall jumps 20s
Tuck jumps 20s
Squat jumps 20s
Barrier Jumps 20s (over something side to side and forward backward)
180 Jumps 20s
Broad jumps (stick landing 5 sec) x5
Bounding in place20s

Very basic strength training and stretching follows.

Like I said nothing special, but the key is to pay attention to the knee position when landing and jumping. Keeping everything in alignment, instead of knees knocking together.

Your strength coach should be able to figure this stuff out for ya.