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Background Total knee arthroplasty(TKA)corrects varus deformity of the knee in patients with severe varus deformity,but it changes ankle alignmentgreatly at the same time.In this study,we aimed to evaluate whether TKA causes secondary clinical problems on foot and ankle in this patients. Methods sixty-eight patients(84 knees)with varus deformity of >15°(study group),and 136 age-matched and sex-matched patients(152 knees)with varusdeformity of ≤15°(control group)were enrolled.For each patient,full-leg standing radiographs were obtained pre-and post-operatively.Mechanical andanatomical axes(HKA and AA),lateral distal femoral angle,medial proximal tibial angle,lateral distal tibial angle(LDTA),ankle joint line orientationangle(AJOA),tibial plafond talus angle(PTA)and talar shift were measured for each patient both pre-and post-operatively.None of the patients hadcomplained symptoms on foot and ankle before TKA.Patients functional outcomes(The American Orthopaedic Foot and Ankle Score(AOFAS)AnkleHindfoot Scale)and Pain(heel pain)were collected at 1year after TKA.