Never had twinges quite as bad as the OP describes. I did have soreness when I first started riding with cleats because they weren't adjusted to my quite radical toeout. So I'm very cognizant of that issue with myself.

I've always ridden with a relatively high cadence and doing some load bearing squats with 2x4 under the heels and 40+ lb. dumbbells parked on each shoulder during the winter in hopes of preparing for whenever it stops snowing. So I do worry about knees more than I used to.

Good luck to the OP and take care your walking as well as riding posture. Make sure your shoes and any arch supports you might use are good. Some of my minor twinges are the result of my toeout (and a related callus) causing me to twist when walking when my feet aren't well protected. I go through lots of "Molefoam" on that callus just so I can walk normally as well as "Molefoam" and ace bandage padding around my brand new spur-heel on my other foot.....So glad to be able to add to an aches and pains thread nowadays .