Movement of the ankle plays a vital role in the relay of information to our brain about how our body is positioned in space. This phenomenon of knowing our body position is referred to as proprioception. Proprioception occurs as a result of nerve endings, in the ankle and other parts of the body, being stimulated or firing an action potential along the nerve in reaction to movement or mechanical deformation of the nerve ending. We have the highest number of “proprioceptors” in our ankles, and then the 2nd most in our neck. As we are bipedal animals, most of our motion first occurs with our feet in contact with the ground. In this article we will look at the action of ankle dorsiflexion (the movement of our ankle bringing our toes towards our shin) and how we can correct it in order to prevent inaccurate movement patterns further up the leg and spine.
As we swing our lower body and use our muscles in our feet and legs we propel ourselves forward. The motion that is created within our joints while doing this helps our brain understand where we are positioned in space and how we are going to react. Are we going to continue walking forward, or are we going to brace ourselves for a fall if we sense an uneven surface? All this “first” information that our body receives from its motion, will help guide us into our next movements. We want this information to be accurate, not faulty. We know that faulty information taken in will guide us to use an incorrect reaction, in this case, over activate some muscles and inhibit others, ultimately leading to a faulty walking pattern. For example, with limited ankle dorsiflexion, the knee will flex more during the stance phase of running, and produce increased medial tibia rotation and increased pronation of the foot. This puts more stress on the quadriceps tendon at its insertion at the tibia and is theorized as one of the mechanisms in causing Osgood-Schlatter disease (1).
Several research articles have reported on the effects of altered dorsiflexion as the cause for patellar or Achilles tendonitis, patellar femoral syndrome, ACL tears and several faulty hip and knee kinetic motions. In addition, there is a risk of increased ankle sprains and fractures with limited ankle dorsiflexion due to the decrease in dynamic balance. Some sports organizations have considered preparticipation screening of dynamic ankle mobility to be warranted when assessing the level of risk of injury for incoming athletes.
How can you assess your ankle dorsiflexion:
In the office I use a few different methods to assess ankle motion.
- Ankle mobility screen (developed by FMS). Standing at wall, fists to the wall, stand in tandem (heel to toe) with the front toes touching the wall, back toes touching the heel of the front foot. Keeping both heels on the ground, bend both knees as much as you can. Have someone view you from the side and determine where your back knee is in relation to your front medial ankle. If your back knee does not reach the back part of the front ankle, you have inadequate ankle mobility. If your back knee reaches or surpasses the front part of your front ankle, mobility is adequate. If your back knee comes to the middle of the front ankle you have “ok” motion that could use some improvement. As in the above pictures.
2. The other test we look at, which is quite simple to do at home and is also a stretch or exercise you can work on, is the half kneeling ankle dorsiflexion test. In the half kneeling position (kneeling with one foot in front, knee at 90 degrees, hip at 90 degrees and the other knee directly under your hip), lean forward over the front knee as far as you can keeping your front heel on the ground. With adequate ankle dorsiflexion, you should be able to bring your knee 4 inches in front of your toes. See the picture below.
In addition to the above, in the office, we can measure active and passive ankle motions in the non-weight bearing position to identify any joint restrictions when the muscles are inactive.
Treatment for ankle dorsiflexion restrictions could involve joint manipulation if there is a true joint mobility problem, practitioner guided or self stretching to the muscles that cross the joint, soft tissue techniques like myofascial release or massage therapy and exercise.
You can try these two tests above to help determine if your ankles are moving through dorsiflexion properly. You can also use number 2 above as a self stretching method to help improve your ankle motion.
If you have questions about whether your ankle dorsiflexion is adequate, contact our clinic to help answer your questions or click on the link below to book your appointment.