The Knee Bone’s Connected to the Ankle Bone

By Chris Centeno, MD /

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knee bone's connected to the ankle bone

When patients come in with a knee problem, they’re often confused when we start examining their ankle. It turns out the writers of the old song “The Knee Bone’s Connected to the Ankle Bone” were wiser than the obvious connection as a knee and an ankle are simply specialized parts of the same machine, and what affects one part of a system affects the other. So can what’s going on in the foot or the ankle predict arthritis in the knee?  A new study suggests that this is the case. Let’s look at this in depth.

The hip, knee, ankle and foot are all controlled by spinal nerves in your low back and operated by an interconnected system of tendons and ligaments, which work as finely orchestrated interconnected pulleys.

This amazing biomechanical synchronization that allows us to sit, walk, run, jump, and dance can, therefore, be negatively affected by even slight changes to the biomechanics at any point in the system. This concept explains seemingly strange phenomena, like the fact that ACL surgery not only negatively affects the biomechanics of the operated knee but also affects the other knee as well! This video explains how straightforward and unnoticed biomechanical issues can change things:

What Is Knee Arthritis?

Knee arthritis is a very common but often misunderstood issue in which pain is caused by the nerves in the knee and inflammation and bone spurs can cause stiffness. Knee arthritis is also a damaging interplay between the bone and cartilage of the knee. Instability from lax ligaments due to injury, age, or surgeries, like meniscus or ACL procedures, causes parts of the knee to be exposed to greater forces than other areas. This additional pressure can cause small defects or holes in the cartilage, leaving areas of the bone exposed, and the exposed bone reacts by thickening.

The important point here is that the instability or injury that causes knee arthritis puts additional force on the knee joint and affects the biomechanics of the ankle and other parts of the interconnected system as well.

What Does My Knee Arthritis Have to Do with My Ankle?

The ankle along with the foot is the part of the machine that hits the ground. The ankle is made up of three main bones, and constraining the movement of these bones are strong ligaments. Also the Achilles tendon connects the calf muscle to the heel bone.

Many of us sprain our ankles during our lifetimes and we think nothing of the consequences. However, more often than not, spraining one of those ligaments impacts other parts of the interconnected system and, therefore, puts additional stress on the tendons and ligaments of the knee, just like stretching or injuring any one of the knee tendons or ligaments changes the biomechanics of the ankle.

The New Study that Pulls It All Together

Understanding this relationship and the fact that biomechanical forces often drive the progression of knee arthritis, a new study looked at whether changes in the Achilles tendon were related to the presence and degree of knee arthritis. To do this they put 93 participants, 63 with knee arthritis and 30 without, through a series of tests comparing the thickness of the Achilles tendon. They found a significant correlation between the degree of Achilles tendon thickening and the degree of knee arthritis. In essence, a clear link between the knee and the ankle.

The upshot?  While it doesn’t take a rocket scientist to understand that the knee and the ankle are connected, our medical care system in orthopedics has gone the opposite direction toward specializing in specific body parts. This hurts patients and actually educates them that parts like a knee and an ankle are separate machines and not just cogs in the interconnected whole. In this respect, alternative-health practitioners have been much smarter than physicians because they have long understood how the body is one machine. Our Orthopedic 2.0 book explores these relationships, so download the book!

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9 thoughts on “The Knee Bone’s Connected to the Ankle Bone

  1. Pamela Sinclair

    Hi,
    I broke my ankle on April 30 last year. Have a plate screwed to my tibia bone. Most days are fine except when I am on my feet for more than 3 hours. My knee and hip (which has osteo arthritis) ache like crazy. I can hardly lift my leg to get into the car. I am a young, generally fit 75 year old and enjoy your articles. I live in Australia and would love to have stem cell treatment if it would fix the cause.

    1. Regenexx Team Post author

      Pamela,

      Unfortunately, you can’t srcew something together that’s meant to move without creating problems elsewhere, and in this case, the hip, knee and ankle are just specialized parts of the same system. So the biomechanical forces of one, affects the others. The important part is figuring out exactly what’s going on, and treating that. Dr. Boundy, the Regenexx Provider in Melborne, would likely be able to help: http://www.nssm.com.au/

  2. Linda Braden

    This is precisely the situation my PT and I are working to correct since my stem cell and PRP injections at your clinic! She does her best to explain the interconnections, but your blog really helps to reinforce not only my grasp of it, but also provides assurance that we’re getting it right, down here in Spring/Tomball, Texas. Thank you for the good info! I have a LOT of habits to change with standing posture and movement, but simply becoming aware has enabled me to really help myself in the process. I so frequently come across people who need to understand their bodies rather than accepting ineffective surgeries as their only option! We must spread the word!!! Thank you again for being so generous with your acquired knowledge.

    1. Kim

      What clinic in Spring/Tomball does stem cell injections?….what clinics in Texas do the injections?

      1. Regenexx Team Post author

        Kim,
        Our Texas Clinic is in Dallas. Please see: http://regenorthosport.com/ Here’s the list of all Regenexx Providers: http://www.regenexx.com/find-a-physician/

  3. DR ALY AM GORRAFA MD

    HOW CAN I GET THE NAME OF PHYSICIANS WHO PERFORM STEM FOR KNEE ARTHRITIS IN CLEVELAND AND SURROUNDING AREA ?

    1. Regenexx Team Post author

      Dr. Aly AM Gorrafa,
      The two closest Regenexx Providers look to be in Toledo and Pittsburgh. Here is the interactive list. Depending on your exact location, another might be closer: http://www.regenexx.com/find-a-physician/

  4. Hemant

    Hi,
    I met small accident in Mar 2014 in which my right leg got twisted to right outer side littlebit from ankle causing injury to ligaments. Dr put plaster for 4 weeks and then all got normal. After 2.5 years (in Dec 2016) my right knee started paining and eventually complete leg below knee (and mostly all veins). I still have pain in my leg and getting worsen day by day. Other drs (orthopedic as well as surgeons) not able to find the cause yet. Doppler test is done. I do not have sciatica. I do not have varicose veins. Is it something related to my ankle injury?

    1. Regenexx Team Post author

      Hemant,

      Problems from past injuries are very common. https://regenexx.com/blog/arthritis-from-injury/ and https://regenexx.com/blog/playing-sprained-ankle/. We’d need to examine you to see what’s going on. These are the locations where you can get that type of exam. Please see: https://regenexx.com/find-a-physician/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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