When pain develops simultaneously in joints like the ankle and the knee without a clear injury, it often signals an underlying issue beyond simple trauma. This discomfort is not typically the result of a sprain or acute impact, but rather a manifestation of a systemic process or a long-developing mechanical problem. Understanding the non-traumatic origins of this joint distress is the first step toward finding an appropriate solution. Joint pain without a specific incident usually points toward conditions that affect the body broadly or chronic stress due to abnormal movement patterns.
Chronic Pain from Autoimmune Conditions
Pain in multiple joints, including the ankles and knees, can often be traced back to autoimmune conditions, where the immune system mistakenly attacks healthy tissues. Rheumatoid Arthritis (RA) is a primary example, causing chronic inflammation in the synovium, the lining of the joint capsule. This inflammation leads to painful swelling and stiffness, frequently affecting the same joints on both sides of the body, such as both ankles and both knees simultaneously.
Systemic Lupus Erythematosus (SLE) is another condition that commonly involves the joints, causing arthritis in the knees and ankles. While SLE joint damage tends to be less destructive than RA, the persistent inflammation still results in discomfort and reduced mobility. Psoriatic Arthritis, which develops in some individuals with psoriasis, also causes inflammatory joint pain that can affect the lower limbs.
The mechanism involves the immune system releasing inflammatory chemicals that target joint structures, damaging cartilage and bone over time. Morning stiffness that lasts for hours is a common characteristic of inflammatory arthritis, differentiating it from mechanical pain that tends to improve with movement. Recognizing this systemic pattern indicates the cause is a widespread inflammatory disease, not an isolated injury.
Hidden Stress from Alignment and Gait
Pain in the ankle and knee without injury is frequently caused by mechanical issues originating in the feet that transfer stress up the leg, a concept known as the kinetic chain. The foot’s interaction with the ground directly influences ankle alignment, which in turn affects the knee joint. Excessive inward rolling of the foot, called overpronation, can cause the lower leg and knee to rotate internally.
This improper rotation places abnormal force on the knee joint, which is designed primarily for hinge-like motion, leading to strain and discomfort. Over time, this poor biomechanics can contribute to Patellofemoral Pain Syndrome (PFP), causing pain around or under the kneecap due to misalignment during movement. Conversely, underpronation (supination), where the foot rolls outward too much, also leads to uneven weight distribution and excessive stress on the knee.
Alignment issues, such as a leg length discrepancy, can also force the ankle and knee to compensate, causing chronic strain without an acute injury. Footwear lacking adequate arch support can exacerbate overpronation and supination, preventing shock absorption and sending undue stress up the kinetic chain to the knee. Addressing these fundamental issues of foot and ankle alignment is necessary to resolve the resulting knee pain.
Metabolic and Infectious Causes
Systemic causes of joint pain include metabolic imbalances and prior infections that trigger inflammation. Gout is a common metabolic form of inflammatory arthritis, resulting from the buildup of excess uric acid in the bloodstream. The uric acid forms needle-like crystals that deposit in the joints, causing sudden, severe episodes of pain, swelling, and redness, which can affect the ankle and knee.
A related condition is Pseudogout (Chondrocalcinosis), which involves the deposition of calcium pyrophosphate dihydrate crystals, also leading to painful joint inflammation, often in the knee. These crystal-induced arthropathies typically present with an acute, intense onset, unlike the slower progression of autoimmune diseases. Infectious causes include Reactive Arthritis, a type of inflammatory joint pain that develops after an infection elsewhere in the body, such as the gastrointestinal or genitourinary tract.
The immune response to the initial pathogen mistakenly attacks the joint tissues, leading to symptoms in the ankles, heels, or knees. Chronic infections like Lyme disease, if left untreated, can also result in migratory or widespread joint pain that includes the knees, long after the initial infection has passed. These systemic causes demonstrate how chemical or microbial factors, rather than trauma, can lead to joint distress.
Recognizing Warning Signs and Next Steps
When joint pain in the ankle and knee occurs without injury, observe for specific symptoms suggesting a serious underlying condition requiring immediate medical consultation. Unexplained warmth, intense redness, or fever accompanying the joint pain can indicate septic arthritis, an infection within the joint that is a medical emergency. Joint swelling lasting longer than three days despite rest, or pain so severe it prevents normal walking, also warrants professional evaluation.
Other concerning signs include joint stiffness that persists for more than 30 minutes in the morning, pain that wakes an individual up at night, or discomfort accompanied by a rash, eye irritation, or unexplained fatigue. A medical professional can use blood tests and imaging to determine if the pain is caused by autoimmune markers, crystal deposits, or mechanical misalignment. Self-diagnosis is inadequate for systemic issues, and early intervention is necessary to prevent long-term damage and maintain healthy joint function.