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• STUDY DESIGN: Case report.• BACKGROUND: Walking plays an essential role in activities of daily living and has varied health benefits. Studies report that gait speed and symmetry are impacted in individuals following total knee arthroplasty (TKA). Unfortunately, abnormal gait patterns persist in individuals after TKA. Downhill walking may provide a simple and feasible exercise regimen to improve gait patterns. The purpose of this case report was to describe the application of a downhill treadmill training program and the subsequent changes in gait patterns in an individual following a unilateral TKA.• CASE DESCRIPTION: The participant was a 59-year-old woman following a right TKA. Downhill gait training was initiated 1 month post TKA and completed for 5 weeks. Outcomes were assessed using questionnaires, mobility tests, strength of quadriceps, and gait patterns. The treadmill speed was determined by the participant's self-selected gait speed on a level surface.• OUTCOMES: The participant's eccentric quadriceps strength in the operated limb significantly increased after the gait training. Her physical function recovered to a level similar to that of previous reports. Postintervention gait analysis was conducted at 2 self-selected speeds, due to an increase in the participant's self-selected gait speed between sessions. The participant demonstrated a more symmetrical gait pattern when walking slower and a more asymmetrical gait pattern at the faster speed.• DISCUSSION: After completion of downhill gait training in conjunction with therapeutic exercises, the participant showed an increase in quadriceps strength and improved physical function. This case report describes the utilization and potential feasibility of downhill gait training in conjunction with outpatient physical therapy for an individual following unilateral TKA.• LEVEL OF EVIDENCE: Therapy, level 5.