Why Do My Feet Invert and My Knees Collide When I Walk or Run? 🦶🏃‍♀️💥

When you're fatigued during a run—or even during walking—you may notice your feet invert excessively (roll outward) and your knees collide or move inward. These compensations can be signs of muscular weakness and poor neuromuscular control, which become more apparent under physical stress or fatigue. Addressing these weaknesses is crucial not only for improving your gait but also for preventing injury and long-term compensation patterns.

Likely Weak or Underactive Muscles (and Related Compensations)

• Gluteus Medius and Minimus (hip abductors)

  • Function: Stabilize the pelvis in the frontal plane and prevent excessive hip adduction and internal rotation.

  • Weakness here can lead to knee valgus (knock-knee) and excessive femoral internal rotation, contributing to knees colliding during walking or running—especially under fatigue (Leetun et al., 2004).

• Tibialis Posterior and Peroneals

  • These muscles are essential for controlling foot inversion/eversion.

  • As they fatigue, you may lose control over inversion, leading to excessive supination or rolling outward of the foot.

• Intrinsic Foot Muscles

  • Weak foot musculature can cause poor shock absorption and instability in foot strike and push-off, contributing to abnormal loading patterns during gait (McKeon et al., 2015).

• Core Musculature (especially obliques and transverse abdominis)

  • A weak core results in proximal instability, which can cascade into poor hip, knee, and ankle mechanics during movement (Willson et al., 2005).

Evidence-Based Exercise Plan to Address These Issues

All exercises below are supported by occupational and physical therapy protocols and peer-reviewed research focused on injury prevention and gait correction in runners.

1. Side-Lying Hip Abduction (Gluteus Medius Activation)

• How: Lie on your side with legs stacked. Lift the top leg ~30° while keeping it straight and hip neutral.

• Prescription: 3 sets of 15 reps each side.

• Progression: Add a resistance band or ankle weights.

• Evidence: Leetun et al., 2004 found that strengthening hip abductors reduces injury risk in runners.

  
  

  

  
  

2. Monster Walks with Resistance Band

• How: Place a loop resistance band above the knees. Perform a mini-squat and step sideways slowly and with control.

• Prescription: 3 sets of 10–15 steps in each direction.

• Goal: Improve frontal plane hip and knee control during gait.

• Evidence: Distefano et al., 2009 showed high gluteus medius activation during monster walks.

3. Single-Leg Romanian Deadlift

• How: Stand on one leg, hinge at the hips, and extend the opposite leg backward while lowering your trunk.

• Prescription: 3 sets of 10 reps per leg.

• Benefit: Improves eccentric control, hip stability, and single-limb stance—all key for running gait.

4. Foot Intrinsic Strengthening ("Short Foot" Exercise)

• How: In standing or seated, attempt to “shorten” the foot by drawing the ball of the foot toward the heel without curling the toes.

• Prescription: 3 sets of 10–15 reps.

• Evidence: McKeon et al., 2015 support this for arch support and improved foot-ground contact.

5. Resisted Eversion & Inversion (Peroneal and Tibialis Posterior Strengthening)

• How: Use a resistance band to perform controlled ankle eversion (for peroneals) and inversion (for tibialis posterior).

• Prescription: 3 sets of 15 reps per direction.

• Goal: Improve ankle stability and prevent excessive inversion or supination during gait.

Ankle Inversion

Ankle Eversion

6. Core Stability: Dead Bug with Resistance

• How: Lie on your back, arms raised, knees bent. Lower one arm and the opposite leg while keeping your spine neutral.

• Prescription: 3 sets of 10 reps per side.

• Evidence: Willson et al., 2005 found that improved core stability leads to better lower extremity alignment during dynamic tasks.

7. Running Form Drills: A-Skips, B-Skips and Unilateral High Knee Drive

• How:

  • Top Left: A Skips-drive knee to hip height and press off stance leg toes and allow forward momentum to propel forward each rep; alternating arm drive

  • Bottom Left: B Skips- drive knee to hip height and press off stance leg toes and allow forward momentum to propel forward each rep; allow knee to elongate with momentum and pull toes downward to ground directly below you; alternating arm drive

  • Right: Power Skips-drive knee above hip height and drive off stance leg to allow forward momentum and vertical momentum to propel you up and forward each rep; powerful alternating arm drive

• Goal: Reinforce efficient neuromuscular patterns and proper knee drive.

• Prescription: 3 x 20 meters, 3 times/week as part of warm-up or cooldown.

Why It Matters

These compensations—foot inversion and knee collision—can present during walking or running, and are exacerbated by fatigue. If uncorrected, they can lead to compensatory movement patterns, placing strain on joints, soft tissues, and your kinetic chain. Strengthening these key muscles improves biomechanical efficiency, reduces injury risk, and helps maintain healthy, stable gait mechanics.

References

• Leetun, D. T., Ireland, M. L., Willson, J. D., Ballantyne, B. T., & Davis, I. M. (2004). Core stability measures as risk factors for lower extremity injury in athletes. Medicine and Science in Sports and Exercise, 36(6), 926–934.

• McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290.

• Willson, J. D., Dougherty, C. P., Ireland, M. L., & Davis, I. M. (2005). Core stability and its relationship to lower extremity function and injury. Journal of the American Academy of Orthopaedic Surgeons, 13(5), 316–325.

• Distefano, L. J., Blackburn, J. T., Marshall, S. W., & Padua, D. A. (2009). Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic & Sports Physical Therapy, 39(7), 532–540.