Regional interdependence between the ankle-foot and hip complexes in musculoskeletal disorders affecting either district: a scoping review

Background Regional interdependence (RI) posits that musculoskeletal symptoms at one site may be influenced by dysfunctions in anatomically distant regions. Although clinicians routinely consider the ankle-foot-hip relationship in the assessment of lower-limb disorders, evidence regarding this relationship has not been comprehensively mapped. Objectives To map the extent of the evidence on RI between the ankle-foot and hip districts in adults with musculoskeletal disorders (MSDs) affecting either region. Methods Six databases were searched up to October 2024. We included studies involving adults with ankle-foot and hip MSDs that investigated RI between the two districts, regardless of study design, publication type, or language. Surgical populations were excluded. Two independent reviewer pairs screened records for eligibility. Data were extracted using a pre-defined form and synthesised descriptively. Results From 10,733 records, 72 studies met inclusion criteria, with most (92%) published since 2011. Cross-sectional designs were predominant (58%). Chronic ankle instability emerged as the most frequently investigated ankle-foot MSD, associated with altered hip muscle activity, kinematics, neuromechanics, and reduced quality of life. Other ankle-foot MSDs (e.g., Achilles tendinopathy, foot misalignment, plantar fasciitis, and osteoarthritis) showed links to both hip kinematics and muscle activity changes. Hip MSDs and hip-focused interventions were also associated with changes in ankle-foot biomechanics and functional outcomes. Conclusion Current evidence supports the relevance of integrating RI principles into the assessment and management of lower-limb MSDs, particularly chronic ankle instability. Further longitudinal and interventional research is needed to clarify causal mechanisms and better characterise the relationship between the ankle-foot and hip complexes.