High Tibial Osteotomy (HTO) affects the other two ipsilateral joints while changing the load axis of the lower limb to alter the knee load distribution. In particular, these changes are more common in the ankle and related to the degree of axis change created by HTO. The impairment of talar tilt was found effective in the occurrence of symptoms in an asymptomatic ankle after HTO. Thorough examination of the ankle before HTO procedure seems essential.