Poor ankle mobility, a silent killer? 🤔

We spend a lot of focus on the importance of ankle mobility because of its direct link to causing multiple problems, and not all of them occurring at the ankle or even foot. Dorsiflexion is the ankles ability to pull the foot and toes toward the shin, while the calf muscles on the back side of the ankle and shin elongate, think opposite of a calf press. Proper ankle dorsiflexion is especially important in sports that require change of direction, explosiveness, and squatting and lunging. Also, people often forget how important it is just function well in life.

Proper gait cycle (walking) is a multi-phase dynamic motion that requires proper heel strike, stance, and toe off. If you are lacking dorsiflexion you may have difficulty going through that dynamic sequence correctly. For example, if you cannot get your knee over your toe (ankle is dorsiflexed in this instance) your ability to lower your body down smoothly when going down stairs will be compromised. This often results in “crashing” down to the next stair or a big hip shift to counterbalance your weight. In both instances this can lead to chronic aches, or in a worst case scenario a fall down the stairs.

The brain and body are super smart and they will find ways to compensate for lack of ankle mobility. Another example of poor ankle dorsiflexion causing some of the common injuries we treat is that if the calf muscles are too tight and you are lacking enough dorsiflexion you will change your gait cycle to essentially pop your heel up early or what we call “early heel rise”. This will put more pressure on the ball of the foot and can lead to conditions like Morton’s neuroma, metatarsalgia, plantar fasciitis, big toe pain, and Achilles issues. Another compensation we see is hyperextension of the knee. If the ankle is restricted you may straighten out your knee harder in order to propel further. This can cause pain in the back or sides of the knee, or make it feel unstable. And lastly, low back pain. If you cannot dorsiflex or move your ankle correctly some people will compensate by shifting their body weight forward and changing their center of mass to be more balanced. The result is a prolonged forward flexed position that can cause low back pain.

This issues are relatively benign in the beginning stages, and to call poor ankle mobility a “silent killer” is mostly hyperbole, but we have research that shows the increase risk in falls that can be fatal in older individuals as well as less desire to be active which can itself be a slow death.

So how do we address this? First we need to establish what good ankle mobility is. Rather than using a goniometer (a physical therapy device to measure angles and range of motion that is often non-reliable) I prefer the kneeling wall test. The test is simple, either standing or in a half-kneeling position place your foot flat on the ground pointing towards a wall or plyo box. While keeping the foot flat(no shoes), drive your knee over your toes and touch the wall/box. Back up your foot 1 inch at a time and repeat. The test is over when your heel shows even the smallest amount of daylight under the heel in order to reach the wall. Measure from the last distance you could tap the point of your knee on the wall/box. Be sure to measure both sides the same way. How did you do? The ideal number is to be able to perform this test with the toes being 5 inches away from the wall/box. When we test this in office we will follow up with questions like was their restriction felt in the calf muscles or did it feel like there was something blocking the front of the ankle.

For some of our patients it may be as simple as tight and shortened calf muscles, in that case our protocol will involve something of the following: calf foam rolling, stretching in various positions, potential change in shoes, and a heavy focus on eccentric strength. In other cases we may recommend banded mobilizations and focused shockwave to break up scar tissue from previous injuries like ankle sprains. Other exercises we commonly use are single leg step down, lunges, front loaded squats, and others.