Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

How Knee Replacement Affects Your Feet

Total knee arthroplasty (TKA) is one of the most common and successful orthopedic procedures performed — over 700,000 per year in the United States. While it reliably relieves knee pain and restores function, patients and surgeons sometimes overlook how a new knee alignment can affect the biomechanics of the rest of the lower extremity — particularly the foot and ankle.

At Balance Foot & Ankle in Howell and Bloomfield Township, we see patients who develop new foot and ankle symptoms after knee replacement, and we work with their orthopedic surgeons to address these issues and optimize their overall post-arthroplasty function.

Correction of Knee Deformity Changes Foot Loading

Many patients undergoing TKA have had significant knee deformity — either varus (bow-legged) or valgus (knock-kneed) — for years. This deformity alters how forces are distributed through the foot during walking: a chronically bow-legged patient, for example, loads the lateral (outer) side of the foot more heavily, while a knock-kneed patient loads the medial (inner) side.

When the knee deformity is corrected to neutral alignment at surgery, the foot suddenly experiences a different loading pattern. Structures that have adapted to years of abnormal loading (tendons, calluses, plantar fascia) are now stressed differently. Some patients develop new arch pain, plantar fasciitis, or metatarsalgia from this realignment — not because the surgery was wrong, but because their feet need time and support to adapt to the corrected alignment.

Gait Changes After TKA

Gait analysis studies consistently show that knee function and biomechanics continue to improve for 12–24 months after TKA. In the early post-operative period, patients often adopt altered gait patterns to protect the healing knee — reduced walking speed, altered step length, and compensatory movements. These patterns can place abnormal stress on adjacent joints including the ankle and foot. Physical therapy-directed gait normalization is essential for optimizing foot health as well as knee function.

Ankle and Foot Arthritis in TKA Patients

Patients who have had end-stage knee arthritis for many years often have coexisting arthritis in the ankle and subtalar joint — conditions that were masked or overshadowed by the knee pain. After TKA dramatically relieves knee pain, patients may become aware for the first time of ankle arthritis that was always present but unnoticed. This is not a complication of TKA but rather the “next in line” problem becoming apparent after the most painful issue is resolved.

Similarly, patients who have hobbled with knee pain for years may have developed habitual foot mechanics (including flat foot deformity from altered gait) that require specific podiatric management after the knee is repaired.

Custom Orthotics After Knee Replacement

Many post-TKA patients benefit from custom orthotics that support the foot in the new alignment created by the knee replacement. Orthotics designed after the knee alignment has been corrected — rather than before — account for the new mechanical environment the foot is operating in. We often see better orthotic outcomes when devices are prescribed at 3–6 months post-TKA after the initial gait adaptation has occurred.

If you’ve had a knee replacement and are now experiencing new or worsening foot or ankle pain, contact Balance Foot & Ankle. We’ll evaluate your foot function in the context of your post-TKA lower extremity mechanics and provide targeted treatment.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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New Foot Pain After Knee Replacement?

Knee replacement surgery changes leg alignment and gait mechanics, which can create new stress patterns in the foot and ankle. We help post-knee replacement patients adapt with orthotics and targeted treatment.

Learn About Post-Surgical Orthotics | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Wylde V, et al. Prevalence of foot and ankle pain after total hip and knee arthroplasty. Clinical Orthopaedics and Related Research. 2012;470(6):1612-1619.
2. Levinger P, et al. Biomechanical changes in the foot and ankle after total knee replacement. Gait and Posture. 2012;36(3):510-515.
3. Mandeville D, et al. The effect of total knee replacement on the knee adduction moment during gait. Clinical Biomechanics. 2008;23(6):814-821.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.