We recently ran into a middle-aged friend and sometime patient who was complaining of growing aches and pains in her knees, hips and back. She wasn't an athlete, or particularly active, so the pain probably wasn't from overuse. She also didn't have a weight problem, so stress on the joints from obesity wasn't the answer. She remarked that she thought she might have Lyme Disease and had set up an appointment with her family physician to be tested. Sorry to hear that, we said, That's truly a painful condition.

And then we looked down at her shoes - the most beat-up, worn-out flats we ever saw.

"You have flat feet, don't you?"

"Yes, I do."

"Do you wear those shoes often?"

"Yes, I love them."

"Throw them away and never wear them again. Those shoes have zero support and flat feet need arch support. I bet if you wear sneakers instead your pain will go away."

"I hadn't thought of that."

Most people assume that the growing pain in their knees, hips, or back is caused by a crippling disease or an unknown injury. But in fact, the source of your pain may actually be rooted in your feet - or more specifically, heels and arches which aren't supported correctly (as in our friend's case), or feet that are out of alignment with your ankle and leg.

The older we get...

As we age we have to take better care of our feet. After forty-plus years of neglect, they gradually become painful, arthritic, misaligned, and prone to bunions and hammertoes. Our feet are designed to distribute and support our body weight evenly across the forefoot and heels, and a critical part of this is the proper alignment of the foot/ankle and the ankle/lower leg.  In the case of those who have flat feet, arch support is required for proper alignment and to avoid fatigue.

When we're out of alignment, or lack arch support, we get tired and sore, which causes us to shift our body weight to get comfortable. Then the sides of our foot, forefoot or heel carry too much weight and our ankles, knees, hips and legs compensate, which causes stress on the joints. And when the stress is continuous, the joints become irritated and painful.

It may be hard to believe that such acute and bothersome pain can be caused by a lack of arch support or the misalignment of your foot/ankle/lower leg. In many cases, a simple change in footwear to a quality pair of athletic shoes, worn as often as possible, is the answer. To correct your alignment and relive fatigue, your podiatrist may also recommend custom orthotics to be worn inside your shoes.

And how is our friend doing now, one month later? She reports that she's been wearing sneakers as often as possible and her back, hip and knee pain is nearly gone. Voila!

If you've ever taken a yoga class, one thing was probably clear immediately: your feet and ankles weren't nearly as strong as you thought they were. In the U.S. and much of the world, we go about our daily business in shoes which protect our feet and our health. If we're athletes, we buy shoes which protect our feet from injuries and hopefully give us a little extra juice when we need it.

But on the downside, those shoes can prevent the muscles in our feet from getting the exercise they need. And as we age, it shows: bunions, hammer toes, aching arches, aching toes, poor balance, and a host of other maladies (some of these are inherited traits).

Strong feet and ankles are essential for anyone, and especially as we age, to maintain our balance. Running, biking, weight lifting and any athletic activity is great, but they tend to develop one side of the body more than the other, due to our natural left-hand, right-hand propensity. Yoga aims to create equal strength and also loosens the joints, helping them avoid injury and maintain flexibility.

One of the first lessons in yoga is how to stand. This may seem silly at first, but our feet are our foundation, and we quickly learn that we need to unlearn some bad habits. Over the years we lean into the sides of our feet, lean back on our heels, lean forward, or shift weight from sore areas. All of these habits change the way we walk and stand, throwing our legs and ankles out of alignment and placing stress on other parts of our body. The result is pain and stiffness anywhere between the toes and neck.

Try these simple yoga-based exercises to build strength in your ankles, feet and toes. Do all exercises barefoot on a flat surface. If you have medical problems with your feet or ankles, or are obese, consult your physician before attempting.

Learn To Evenly Distribute Your Weight

The strength of your feet - and especially your arches - determines if your leg is aligned with your ankle. Strengthening your arches starts with an awareness of how you stand.

Standing upright in bare feet, sense where your weight falls in your feet. Your feet are meant to carry your body weight evenly - not back on the heels or on the balls of your feet. Press down evenly through the heels, the balls, and your toes. You'll feel the difference in your balance immediately. While standing upright and evenly balanced, spread the soles and toes as much as you can and reach the toes forward.

Stretch and Strengthen Your Feet

One of the most common yoga poses, Downward-Facing Dog, stretches the soles of your feet and strengthens your arches. In this position, gently push your heels toward the floor as much as possible. Learn how to do it here.

To stretch the tops of your feet and strengthen your ankles, try Hero Pose (only do this if you have no knee problems). Kneel on the floor, keeping your thighs perpendicular to the floor and touch your inner knees together. Slide your feet apart, slightly wider than your hips, but keep the tops of your feet flat on the floor. Then sit down between your feet. If your buttocks don't rest comfortably on the floor, support them with a thick book placed between your feet. Now lift your sternum, sitting as upright as possible, and try to release your shoulder blades away from your ears. Hold for 1 minute.

Raising yourself on your toes is a simple and excellent way to strengthen your feet. While this may seem easy at first, try doing it very slowly. You'll be surprised at how much effort you'll expend.

Strengthen your toes

Stand with your feet so that they're directly under your hips. Try to lift just the big toe on each foot, while keeping the other toes on the floor. Then do the opposite: lift all the toes except the big toe. Switch back and forth. You'll find that one part of that exercise will be a lot easier than the other. That's because those who pronate (roll the foot inward when they walk) typically have a hard time lifting their big toes, and those who supinate (roll the foot outward) have a hard time lifting the other toes.

Leaning is Exercise

Leaning teaches us how to balance our weight across our feet. Those who shift their weight to their heels leave the front of their foot without much to do, and the foot weakens.

Stand with your feet a comfortable distance apart and put a soft bend in your knees. Lean forward at the ankle as if you were about to ski down a slope. Do not lean from the waist or hips - keep the lean in your ankles. This exercise wakes up the muscles in your toes and the soles of your feet.

If your feet feel tired after these exercises, that's good - it means that the muscles are being worked. If your feet are sore, that's not good - back off a little next time around.