When your knee hurts, you probably don’t immediately think about your ankle. You think about the knee.

Maybe you strengthen your quadriceps. Maybe you stretch your hamstrings. Maybe you avoid squatting, stairs, lunging, golf, tennis, or pickleball because those activities seem to make the knee hurt.

But your knee does not function independently. It sits between your hip and ankle, and what happens at either of those joints can influence how your entire leg moves.

One particularly important movement is ankle dorsiflexion — the ability of your shin to move forward over your foot while your heel remains on the ground.

You need ankle dorsiflexion every time you:

• Walk
• Go downstairs
• Squat
• Lunge
• Step off a curb
• Hike
• Play pickleball
• Play tennis
• Move through uneven terrain on a golf course

When ankle dorsiflexion is limited, your body still needs to complete those movements — so it may compensate somewhere else.

Research supports this relationship. A systematic review and meta-analysis found that reduced ankle dorsiflexion was significantly associated with dynamic knee valgus—a movement pattern involving medial displacement of the knee during weight-bearing tasks.¹

That doesn’t mean limited ankle mobility causes every case of knee pain. But it does mean that if your knee hurts, your ankles may deserve a closer look.

What Is Ankle Dorsiflexion?

Ankle dorsiflexion is the movement that occurs when the top of your foot moves toward your shin. But the more functional way to understand it is this:

Stand with your foot flat on the floor. Now bend your knee forward over your foot without allowing your heel to lift. That’s ankle dorsiflexion.

You use this motion constantly. When you walk, your shin needs to progress over your foot. When you descend stairs, your ankle needs to bend as your body lowers. When you squat, your knees move forward as your hips move downward. When you lunge for a pickleball or tennis ball, your ankle needs enough mobility to allow your body to lower over your foot.

If the ankle cannot provide enough motion, your body has to find another strategy. And that is where the knee can become involved.

Think of Your Leg as a Movement Chain

In our previous discussion about hip strength and knee pain, we talked about the lower extremity as a chain:

Trunk → Pelvis → Hip → Knee → Ankle → Foot

Movement at one joint can influence movement at another. If your hip lacks strength or mobility, the knee may compensate. The same principle applies below the knee.

If your ankle doesn’t move adequately, your body may compensate through the:

• Foot
• Knee
• Hip
• Pelvis
• Trunk

Research examining ankle dorsiflexion and lower-extremity mechanics supports this concept. When dorsiflexion is restricted, compensatory movement can occur through multiple planes of motion elsewhere in the kinetic chain.¹

That is why simply treating the location of pain may not always address the entire problem.

Why Does Your Ankle Need to Move When Your Knee Bends?

Try this experiment. Stand facing a wall with your feet flat. Keeping your heel down, slowly bend one knee forward. Your shin moves over your foot.

Now imagine that the ankle suddenly stops moving. What happens if you still need to lower your body? You have several options. You might:

• Lift your heel
• Turn your foot outward
• Allow your foot to roll inward
• Shift your weight
• Move your knee differently
• Move your hip differently
• Lean your trunk

Your body is extremely good at finding ways to complete a task. The problem is that a compensation that works temporarily may not always be the most efficient strategy when repeated thousands of times.

Limited Ankle Mobility Can Change Knee Movement

One of the clearest research connections between ankle mobility and knee mechanics involves dynamic knee valgus.

Dynamic knee valgus is a movement pattern in which the knee moves inward relative to the hip and foot during a weight-bearing activity. It may occur during:

• Squatting
• Lunging
• Stepping down
• Running
• Landing
• Changing direction

A systematic review and meta-analysis involving 17 studies found that reduced ankle dorsiflexion was significantly associated with dynamic knee valgus.¹

Importantly, the relationship was found whether ankle mobility was measured in weight-bearing or non-weight-bearing positions.¹

This does not mean, “A stiff ankle automatically causes your knee to collapse inward.” Human movement is more complicated. Knee position can also be influenced by:

• Hip strength
• Hip mobility
• Foot mechanics
• Anatomy
• Balance
• Coordination
• Fatigue
• Task demands

But ankle mobility is one factor worth considering.

Why Ankle Mobility Matters When You Squat

A squat requires coordinated movement through three major joints: hip, knee, and ankle. As you lower your body, your hips bend, your knees bend, and your ankles dorsiflex.

If the ankle does not move enough, your body may compensate. You may:

• Turn your feet outward
• Lift your heels
• Shift your weight backward
• Lean your trunk
• Change the position of your knees
• Reduce squat depth

None of these compensations automatically means something is “wrong.” But if you have knee pain during squatting, assessing ankle mobility may provide useful information.

The relationship becomes especially important because deeper knee flexion can substantially increase patellofemoral loading during squat-type movements.²

Rather than simply saying, “Squats are bad for my knees,” a better question may be: “What is limiting my ability to squat comfortably?” For some people, ankle mobility may be part of the answer.

Why Ankle Mobility Matters Going Down Stairs

Going downstairs can be particularly difficult for people with knee pain. Why? Because you have to control your body as gravity pulls you downward.

Your quadriceps work to control knee bending while your ankle dorsiflexes as your body moves over the supporting foot.

If the ankle doesn’t move adequately, you may compensate by:

• Turning your foot outward
• Dropping your pelvis
• Moving your knee differently
• Lowering yourself more abruptly
• Holding the railing
• Rotating your body sideways

Again, these are strategies your body may use to accomplish the task. But if going downstairs consistently aggravates your knee, it makes sense to examine more than the knee.

Why Ankle Mobility Matters When You Lunge

Lunging requires even more ankle mobility. As you step forward and lower your body, the shin of the front leg needs to move over the foot. That’s especially important during sports.

Think about lunging toward the kitchen line during pickleball. Or reaching for a short tennis ball. If your ankle doesn’t have enough mobility, your body may compensate through the foot, knee, hip, or trunk.

This is one reason an active adult may be able to walk comfortably but experience knee pain during sports. Walking does not require the same amount or speed of ankle motion as a deep, rapid athletic lunge.

Why Your Ankles Matter for Pickleball

Pickleball places significant demands on ankle mobility because of the repeated:

• Lunging
• Squatting
• Forward movement
• Side stepping
• Stopping
• Direction changes

Imagine moving quickly toward the kitchen line. You plant your foot. Your knee bends. Your shin moves forward. Your body lowers. Then you have to stop and push yourself backward. The ankle, knee, and hip must work together.

If ankle dorsiflexion is limited, your movement strategy may change. For someone experiencing knee pain during pickleball, evaluating ankle mobility can therefore be an important part of understanding the entire movement pattern.

Why Your Ankles Matter for Tennis

Tennis places even greater multidirectional demands on the lower extremities. You may need to sprint forward, stop, lunge, push backward, move laterally, change direction, and repeat.

During a wide forehand or short-ball retrieval, your ankle must accommodate the position of your body as you lower toward the court. If ankle mobility is restricted, compensations may occur elsewhere.

This is why a tennis-specific knee evaluation should not necessarily stop at the knee. We may need to evaluate hip mobility, hip strength, knee strength, ankle mobility, balance, and deceleration — because tennis requires all of them.

Why Ankle Mobility Matters for Golf

Golf presents a different challenge. You may not perform deep lunges or rapid direction changes, but your feet and ankles still play an important role.

During the golf swing, forces move from the ground upward through the feet, ankles, knees, hips, pelvis, and trunk. Your ankles help with balance, weight transfer, rotation, ground interaction, and maintaining posture.

Then there is the other part of golf: walking the course. Walking 18 holes can involve several miles over hills, uneven terrain, side slopes, bunkers, and different surfaces.

If ankle mobility is limited, your body may compensate differently as fatigue increases. For golfers with knee pain, evaluating the ankle can therefore be useful both for swing mechanics and walking capacity.

What Causes Limited Ankle Mobility?

There are several possibilities.

Calf Muscle Stiffness

Your gastrocnemius and soleus muscles cross or influence the ankle and can restrict dorsiflexion when they are stiff.

Previous Ankle Sprain

A history of ankle injury can sometimes leave residual stiffness or altered movement.

Previous Fracture or Surgery

Structural changes after injury or surgery may limit ankle motion.

Joint Stiffness

The ankle joint itself may have reduced mobility.

Reduced Activity

If you rarely move into deeper ankle dorsiflexion positions, your available range may gradually become limited.

Habitual Footwear

Certain footwear may reduce how often you use your available ankle motion.

The important point is that not all ankle restrictions have the same cause. That matters because the appropriate intervention may differ.

How Can You Tell If Your Ankle Mobility Is Limited?

One commonly used clinical assessment is the weight-bearing lunge test, sometimes called the knee-to-wall test.

A Simple Screening Version

Stand facing a wall. Place one foot several inches away. Keep your heel flat. Slowly move your knee toward the wall. Can your knee touch the wall without:

• Your heel lifting?
• Your foot excessively turning outward?
• Your arch collapsing dramatically?
• Your body twisting?

Then compare sides. A significant difference between ankles may be useful information.

However, this is only a screening test. It does not tell you by itself why the ankle is restricted or whether the restriction is causing your knee pain. That requires a broader assessment.

Does Limited Ankle Mobility Cause Knee Pain?

This is where we need to be precise. Not necessarily.

Research demonstrates an association between reduced ankle dorsiflexion and certain altered knee movement patterns, particularly dynamic knee valgus.¹

But association is not the same as causation.

Similarly, research examining foot and ankle characteristics in people with patellofemoral pain has produced mixed findings, and a systematic review concluded that the available evidence linking foot/ankle alignment directly with patellofemoral pain remains limited and conflicting.³

That distinction matters. We should not tell everyone with knee pain, “Your ankles are tight—that’s the cause.” Instead, we should ask, “Is ankle mobility one of the factors affecting how this particular person moves?” That is a much more useful clinical question.

What Can You Do to Improve Ankle Mobility?

If limited ankle dorsiflexion is contributing to your movement limitations, several strategies may help. The appropriate approach depends on what is causing the restriction.

1. Calf Stretch With the Knee Straight

This primarily targets the gastrocnemius. Stand facing a wall. Place one foot behind you. Keep the heel down and the knee straight. Move your body forward until you feel a comfortable stretch in the calf.

2. Calf Stretch With the Knee Bent

Bending the knee changes the emphasis toward the soleus. Keep the heel down. Allow the knee to bend forward over the foot. You should feel the stretch lower in the calf.

3. Knee-to-Wall Mobility Exercise

This is a more functional way to work on dorsiflexion. Place your foot near a wall. Keep your heel down. Move your knee toward the wall. Return. Repeat under control. As mobility improves, gradually move the foot farther from the wall.

4. Split Squat

A split squat can combine ankle mobility, hip strength, quadriceps strength, and balance. Start with a comfortable range. Gradually allow the front knee to move forward while keeping the heel in contact with the floor. Progress depth and resistance as tolerated.

5. Calf Raises

Mobility is not the entire story. Your ankle also needs strength. Calf raises help develop the muscles responsible for controlling and producing force through the ankle.

A progression might include: two-leg calf raise → single-leg calf raise → added resistance → faster or sport-specific loading.

This is especially important for active adults who want to return to tennis, pickleball, golf, hiking, or longer-distance walking.

Don’t Just Stretch Your Ankles

This is another common mistake. If ankle mobility is limited, the assumption is often, “I just need to stretch my calves.” Maybe.

But perhaps the restriction is coming from the joint. Perhaps you have a previous ankle injury. Perhaps your strength is limited. Perhaps your balance is poor. Perhaps you have adequate passive ankle mobility but don’t use it effectively during movement.

That is why treatment should address the reason for the limitation, not simply the location.

Your Ankle Also Needs Strength and Control

Mobility without control is not enough. Suppose you improve your ankle range of motion. Great. But can you control that new range while walking downhill, descending stairs, lunging, stopping quickly, balancing on one leg, or playing tennis or pickleball?

Your ankle needs both mobility and strength. And your entire leg needs mobility, strength, balance, and coordination. That is the difference between improving a measurement and improving function.

What If My Ankle Mobility Is Fine but My Knee Still Hurts?

Then we keep looking. Your knee pain may involve:

• Quadriceps weakness
• Hip weakness
• Knee mobility
• Hip mobility
• Meniscus-related symptoms
• Patellofemoral irritation
• Osteoarthritis
• Tendon problems
• Activity volume
• Training errors
• Sport-specific movement
• Other medical or musculoskeletal factors

Ankle mobility is one piece of the puzzle. It should not become another one-size-fits-all explanation.

Why This Becomes More Important After 50

Mobility can gradually change as we age, especially if we stop regularly using certain ranges of motion. But age alone is not the problem.

The bigger issue is often the combination of less mobility, less strength, less balance, and higher activity demands.

Perhaps you sit for much of the week. Then play pickleball Saturday morning. Perhaps you rarely walk hills. Then take a European vacation involving 15,000 steps per day. Perhaps you rarely strength train. Then walk 18 holes on consecutive days during a golf trip.

Your body is being asked to perform movements it may not regularly practice.

Maintaining ankle mobility is therefore not just about preventing knee pain. It contributes to your ability to walk, squat, climb stairs, hike, travel, golf, play tennis, play pickleball, and remain physically independent.

What Should a Comprehensive Knee Pain Evaluation Include?

If you have persistent knee pain, simply evaluating the knee may not provide the whole answer. Depending on your symptoms and goals, an assessment may include:

• Knee mobility — Can the knee fully bend and straighten?
• Quadriceps strength — Can your thigh muscles generate and absorb enough force?
• Hip strength — Can your hips control your pelvis and thigh?
• Hip mobility — Do your hips have the movement required for your activities?
• Ankle dorsiflexion — Can your shin move adequately over your foot?
• Calf strength — Can your ankle produce and absorb force?
• Balance — Can you control your body on one leg?
• Functional movement — How do you walk, squat, step down, lunge, and climb stairs?
• Sport-specific movement — If your goal is golf, tennis, or pickleball, eventually we should assess the movements required for that sport.

For people with patellofemoral pain, evidence-based clinical guidelines similarly recommend assessing movement patterns and physical impairments rather than treating all knee pain as the same condition.⁴

Frequently Asked Questions About Ankle Mobility and Knee Pain

Can tight ankles cause knee pain?

Limited ankle mobility may contribute to altered lower-extremity movement in some people, but it does not automatically cause knee pain. Research has found an association between reduced ankle dorsiflexion and dynamic knee valgus.¹ Whether that relationship contributes to your symptoms depends on your individual movement pattern and other factors.

How do I know if my ankles are tight?

A weight-bearing knee-to-wall test can provide a simple screen. If you cannot move your knee forward over your foot without lifting the heel or significantly changing your foot position, ankle dorsiflexion may be limited. Comparing one side with the other can also be useful.

Can improving ankle mobility help knee pain?

Potentially, if restricted ankle mobility is contributing to the movement strategy associated with your symptoms. But knee pain often has multiple contributing factors, so ankle mobility should usually be considered alongside hip strength, knee strength, balance, activity volume, and movement mechanics.

Why does ankle mobility matter when squatting?

As you squat, your shin needs to move forward over your foot. That requires ankle dorsiflexion. If dorsiflexion is limited, your body may compensate by lifting the heel, turning the foot, shifting the trunk, changing squat depth, or altering knee and hip movement.

Why does ankle mobility matter for pickleball?

Pickleball requires repeated lunging, stopping, and direction changes. These movements require coordinated motion through the ankle, knee, and hip. Limited ankle mobility may change how you perform those movements.

Why does ankle mobility matter for tennis?

Tennis requires deep lunges, rapid deceleration, lateral movement, and changes of direction. Your ankle must accommodate the position of your body while your knee and hip manage substantial forces.

Should I stretch my calves if my knees hurt?

Not automatically. Calf stiffness may contribute to limited ankle dorsiflexion, but ankle restrictions can have several causes. Stretching may be appropriate for some people but should not replace a comprehensive assessment when knee pain persists.

Stop Looking at the Knee in Isolation

The biggest takeaway is simple: your knee is part of a movement system.

If your knee hurts, we absolutely need to evaluate the knee. But we should also ask:

• How strong are your hips?
• How well do your hips move?
• How strong are your quadriceps?
• How well do your ankles move?
• How strong are your calves?
• How is your balance?
• How do you squat?
• How do you step down?
• How do you lunge?

And most importantly: what are you trying to get back to doing?

The mobility required to walk around your house is very different from the mobility required to lunge for a pickleball, chase a tennis ball, hike through Europe, or negotiate hills while walking 18 holes.

At Kriz Mobility and Vitality in Bonita Springs, Florida, we work with active adults who want to understand not simply where they hurt, but why their body is having difficulty performing the activities they want to do.

That means looking at the entire movement system — including the hips, knees, ankles, strength, balance, mobility, and activity-specific demands.

Because the goal isn’t simply to make your knee feel better. The goal is to build a body capable of doing the things that matter to you.

Move better. Live better. Stay Active for Life.

References

1. Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: a systematic review and meta-analysis. Phys Ther Sport. 2018;29:61–69. doi:10.1016/j.ptsp.2017.07.003.

2. Hartmann H, Wirth K, Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med. 2013;43(10):993–1008. doi:10.1007/s40279-013-0073-6.

3. Martinelli N, Bergamini AN, Burssens A, Toschi F, Kerkhoffs GMMJ, Victor J, Sansone V. Does the foot and ankle alignment impact the patellofemoral pain syndrome? A systematic review and meta-analysis. J Clin Med. 2022;11(8):2245. doi:10.3390/jcm11082245.

4. Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2019;49(9):CPG1–CPG95. doi:10.2519/jospt.2019.0302.