Knee Arthritis Caused by a Bad Ankle?

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It’s always interesting to see how modern medicine doesn’t care about how a problem began. This is generally because doctors don’t get paid much to figure things out, just to fix what’s broken. However, at Regenexx we try hard to figure out the complex reasons why our patients have their problems, as that increases the chances that we’ll be successful helping them recover. I’d like to go over such as case this morning.

Forces from the Ground Matter

How your foot hits the ground can be a big deal. Go and check a pair of well-worn shoes. Look at one of the heels. Does it wear evenly, or do you tend to wear down one side or the other more? I personally tend to wear down the outside of my heel, meaning my feet want to supinate rather than pronate. Others have feet that tend to want to go the opposite way.

This change in how forces travel up the leg can obviously impact the next joint up, the knee. These abnormal forces can preferentially wear out the cartilage in one compartment or another. In our case this morning, an old ankle fracture caused too much wear and tear on the inside compartment of the knee, which caused arthritis.

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How an Old Ankle Fracture Can Cause Knee Problems

The X-ray above shows a hidden problem. This is a patient who was seen for left knee arthritis. As I was reviewing all of his X-rays, this one stuck out because of the hardware in his left ankle. He told me that his body felt like it was shifted to the left. When I measured the angle between the floor and the tibia bone, it was different. Turns out his left ankle had been set at a different angle than his right, and this was, in fact, pushing his body to the left. In fact, this also was causing extra compression on the inside part of the left knee, consistent with arthritis forming at that location.

How Can This Problem Be Helped?

While we can’t fix the angle of his ankle, we can use orthotics to help this foot hit the ground better. So in order to help his knee, we need to correct these ground forces as well as use a stem cell treatment. Hence, before he gets the latter, I’ll need to see another X-ray in those orthotics and remeasure his angles.

The upshot? Knowing what’s happening as your foot hits the ground is critical to discovering why your knee or hip hurts. The problems go the other way as well: issues in the low back can cause issues down the other way, toward the knee. So it’s all connected! Hence, a knee exam should always include an exam of your foot/ankle, hip, and back! If that’s not what you’re getting, then find a new doctor!

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This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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8 thoughts on “Knee Arthritis Caused by a Bad Ankle?

  1. Dwight Alexander

    Good afternoon,
    I am an ex football player and I believe my injuries to my lower back and now my knee are directly related to angle injury

  2. David Davenport

    Here is a suggestion for the Regenexx team: give us some guidance on the optimum amount of pronation when running.

    How can a person tell if he or she is over- or under-pronating?

    1. Regenexx Team Post author

      Pronation puts uneven stress on your knee. There are self tests in the Regenexx ebooks: Another simple self check is to have someone video you running towards them, focusing on your legs, kind of like this: There is alot of info on the website: Please see: and and

  3. Robin Baumgartner

    Dr. Centeno,
    I had a phone interview with you a couple of years ago to discuss my knee arthritis. I had sent you MRI’s for both knees and you told me I had a “weird left leaning” thing going on and that no matter what avenue I chose to correct my problem, it would come back because I was so out of alignment. You recommended Egoscue postural training, which I looked into right away . I made appointments with Zac in the Seattle office and it has made such a difference! I am hyper aware of my posture now, and continue to do simple postural exercises and it is buying me time. So, thank you for your great advise! I’m hoping that I don’t have to see you for a few more years for my knees, although my thumbs may be needing your attention soon….

    1. Regenexx Team Post author

      Great to hear! Thanks for the update. Egoscue is a really effective tool!

  4. John Kelly

    I have a degenerative medial meniscus and I am another ex college football player. My shoes are worn on the outside as well (and I have an “alta knee cap”). Can supination lead to medial meniscus degeneration? Thanks – John K.

    1. Regenexx Team Post author

      That all makes sense as supination would put additional stress on the medial compartment of the knee. Please see: and

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