Fitness woman doing lunges exercises for leg muscle training. Active girl doing front forward one leg step lunge exercise

When most people think about foot and ankle injuries, they don’t think to blame the buttocks. But as an orthopedic surgeon treating athletes, dancers, and active individuals, I see it all the time: weak gluteal muscles are often the hidden culprit behind chronic lower extremity problems, including medial foot pain, knee instability, meniscus tears, iliotibial band syndrome, and even overuse injuries that ruin careers before they start.

Whether it’s a ballerina forcing turnout through her foot or a high school athlete landing a jump with a knock-kneed collapse, the chain reaction often starts at the hip, and more specifically, with gluteal weakness and tightness.

The Foundation of Lower Limb Stability: The Gluteal Complex

The gluteus medius and minimus muscles act as powerful abductors and pelvic stabilizers, particularly in single-leg stance and dynamic activity like running, jumping, or dancing. When these muscles are weak or inhibited, the hip cannot resist adduction or internal rotation.  These are the two motions that trigger a domino effect down the kinetic chain.

Here's what that chain reaction looks like:

Weak Glutes → Hip Adduction → Knee Valgus (knock knees) → Foot Collapse 


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1.    Hip Adduction & Internal Rotation:
Weak gluteus medius leads to pelvic drop and inward drift of the thigh during weight-bearing. This pattern is common in dancers with tight hip flexors and underdeveloped glutes, particularly when turnout is forced.

2.    Valgus Collapse at the Knee:
As the thigh collapses inward, the knee drifts into valgus.  This places medial stress on the joint capsule and lateral overload on the tibiofemoral compartment. This creates the perfect storm for patellofemoral pain, MCL stress, and meniscal injury.

ALERT: WEAK GLUTES CAUSE ANTERIOR KNEE PAIN!!! Patellofemoral syndrome, patellar tendinitis, and patellar chondromalacia.

3.    Medial Foot Overload & Hindfoot Valgus:
The downstream effect of a valgus knee is even more detrimental at the ankle. As the tibia internally rotates and collapses medially, the foot compensates with excessive pronation. Over time, this leads to:

  • Posterior Tibial Tendon (PTT) overload and dysfunction
  • Spring ligament attenuation
  • Flexor Hallucis Longus (FHL) tendinopathy- career ending in dancers!
  • Hindfoot valgus deformity and flatfoot progression

The Ballerina Example: Turnout Gone Wrong

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Ballet dancers provide the perfect clinical model. A dancer with restricted hip external rotation and weak glutes often compensates by forcing turnout through the knee and ankle. This not only strains the medial ankle ligaments and tendons but also destabilizes the knee. Over time, this leads to posterior tibial tendonitis, FHL tears, plantar fasciitis, bunions, and even early arthritis, all from the hip’s failure to do its job. 

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Athletic Implications: Jumping, Cutting, and Landing Mechanics

In athletes, especially females, this dysfunctional pattern is a well-documented contributor to ACL tears and chronic medial foot pain. A glute-deficient landing causes the knee to fall inward and the arch to collapse, multiplying ground reaction forces and predisposing to injury.

Common findings in these patients:

  • Patellofemoral pain
  • Medial tibial stress syndrome
  • Posterior tibial tendon dysfunction
  • Chronic ankle instability
  • Spring ligament strain and navicular overload

What We Do at P.O.W.

At Prisk Orthopaedics and Wellness, we look at the body as a system, not just isolated joints. That’s why dancers, gymnasts, and athletes in Pittsburgh trust us to identify the real cause of their injury.

We evaluate:

  • Hip mobility and gluteal strength
  • Knee tracking and valgus collapse during movement
  • Foot alignment, arch integrity, and tendon function
  • Weight-bearing CT and gait analysis for precise structural diagnosis

Whether the solution involves a targeted glute strengthening program, orthotics, regenerative treatment for overstressed tendons, or surgical correction of deformity, the first step is identifying the root cause: weak glutes.

The Takeaway: Train the Hip to Save the Knee and Ankle

If you're dealing with chronic knee or ankle pain, don't just chase the symptoms. The problem may be higher up at the hip. Restoring gluteal strength and mobility not only relieves pain but also prevents long-term damage to the foot, ankle, and knee.

Schedule a comprehensive evaluation today at orthoandwellness.com and let us help you rebuild from the hip down.