Experts assessed the radiologic factors related to ankle pain before and after total knee arthroplasty (TKA) among patients with a varus osteoarthritic knee. They enrolled 55 patients (65 ankles) with a varus osteoarthritic knee who had undergone TKA and were followed up for >24 months. Findings suggested an association of residual varus deformity with ankle pain after TKA. The patients who complained of pain before and after TKA, their ankles ought to be evaluated. These patients were given careful attention to the correction of alignment during TKA.