How we off load can affect the tragectory of the knee sagittal hinging and it can affect the frontal, sagittal and rotational planes at the hip.
We can see here that a nice high gear medial foot toe off will draw the knee in a more sagittal direction (knee over foot, hip over knee) where as a lateral foot toe off, low gear off the lateral metatarsals could easily encourage the knee into the frontal plane, and the hip into the frontal and lateral rotational planes (knee outside the foot, hip outside the knee).
Lack of strength or awareness or endurance on a long run to endure the "more normal" medial toe off could lead to some knee tracking challenges and pathomechanical set up at the knee and hip, or elsewhere for that matter.
It is the clinicians job to find out if this is a factor, whether it is anatomic (torsion of long bones), weakness, lake of proprio/awareness or a combination of them.
Sometimes the smallest of details in how your client moves can get you the answers you need as to why your client may be in pain.