Non-Clinician's Guide to Ankle Dorsiflexion

 This blog post is regarding limited ankle dorsiflexion – the biomechanical implications, the injuries that may result, how to test it and what to do about it.  This is the “non-clinician’s” version.  If you are a clinician, or want to read the references behind anything I have said below, please click here to be brought to the “clinician’s version”.  Mind you, the clinician’s version is very detailed and lengthy with many, many references.

  If you are still reading up to this point, I am assuming you are not a clinician/biomechanist/healthcare provider..

What is Ankle Dorsiflexion?

  Ankle Dorsiflexion is the action of closing the angle between the front of the shin and the top of the foot.  This could be done in a couple ways: 

   1) If the foot isn’t fixed to the ground, ankle dorsiflexion is the action bending the ankle in a way that brings the toes and foot upward toward the shin bone

Ankle DF with the foot moving

   2) If the foot is fixed on the ground, ankle dorsiflexion is the action of the knee and shin travelling forward over the foot. 

Ankle DF with the foot fixed to the ground

What Happens when Ankle Dorsiflexion is Limited?

We all need to have a certain amount of mobility in ankle dorsiflexion (DF) in order to run, walk, go up or down stairs, squat, get up out of a chair etc.  Imagine trying to do those tasks while wearing a ski boot and you can get an idea why ankle DF is so important.

 Limitation in ankle DF range of motion has been shown to cause many compensations.  For example, a poor mobility in ankle DF has been shown to cause the arch of the foot to flatten and the foot to roll inward (pronation).  This is because it is thought that we can get as much DF from the bones of the foot as we can from the ankle itself.  Limit the dorsiflexion in the ankle and we try to compensate by adding dorsiflexion motion to the foot.  Further up the leg, limited ankle DF causes limitations in knee bending and also, the knee can collapse inward.

   Imagine trying to squat with limited ankle DF.  If your knees can’t travel forward over the toes because the ankle is stiff, your center of gravity will shift backward.  In order to compensate, people tend to bend their trunk forward more so they can shift their body weight back over their center of support – their feet.  Bending the trunk forward more can put more load on the low back.

Can Limited Ankle Dorsiflexion Cause Injury?

  These compensations listed above have been shown in biomechanics laboratories around the world.  Unfortunately, our bodies pay a price for these compensations.  Prospective studies show that people with limited ankle DF suffer from more knee injuries, foot and ankle injuries and just more injuries in general.  A prospective study is where you perform some test on a group of people at the start of the study and then follow them for a given period of time.  For example, it was recently shown that basketball players who have limited ankle DF sustained up to 10X more incidents of patellar tendonitis (a type of knee pain) that those players who had adequate ankle DF at the beginning of the season.

How Do I Know if I Have Limited Ankle Dorsiflexion?

  There is a relatively simple way to test your ankles to see if you have adequate ankle DF range of motion.  It is called the weight bearing lunge test.  The test is contained in the video below.  You should be able to get your knee forward of your toes by approximately 10cm (4 inches)

[vimeo]https://vimeo.com/73530410[/vimeo]

What Can I Do If My Ankle Dorsiflexion is Limited?

  Now we come to the really difficult issue.  Often times, increasing your ankle DF range of motion can be as simple as a regular routine of calf/ankle stretching.  However, when it comes to the question of “what can I do about it“, the real answer is…”it depends.”

  There are a tremendous number of reasons you may have limited ankle DF.  Some may be soft tissue based (tight muscles and tendons) that you can stretch your way out of, but often times, the limitation is within the joint – maybe a type of arthritic condition, maybe the shape of the bones is just the way you grew, maybe there is some damage in the cartilage…it’s tough to tell unless you know what you’re looking for. 

  If you have limited mobility and have gotten the ankle looked at by a qualified health professional (I would really recommend someone who knows ankles – not just a general healthcare provider), you may want to try therapy from a physical therapist or chiropractor.  There are also some self-mobilization procedures you can do.  Mike Reinhold has provided some great examples on self-mobilization techniques for increasing ankle DF.

  As always, please consult with your healthcare provider before undertaking any of these porcedures.

12 Comments so far:

  1. […]    Previously, I made a post called The Definitive Guide to Pronation.  This is another lengthy, detailed post, but now I’m moving up the kinetic chain.  This post is on restricted ankle dorsiflexion (DF). It is really designed for clinicians, but if you are not a clinician you’re in luck. I created a “patient version” located here. […]

  2. Alicia says:

    In judging limited ankle dorsiflexion, you say above “You should be able to get your knee forward of your toes by approximately 10cm (4 inches)” Do you mean you should be able to get your knee forward of your toes by approximately 10cm (4 inches) BEFORE YOUR HEEL BEGINS TO RISE?

    Just trying to clarify, I can measure about 2.5 inches between my big toe and the wall before my heel begins to rise when lunging as shown in your video.

    Thanks

    • Kevin Maggs says:

      Alicia,
      Yes, your knee should be able to be approx 4-5 inches past your toes before your heel raises off the ground. On way to be sure our heel isn’t coming off the ground is to put a piece of paper under the heel and have someone gently try and pull it out with a steady, gentle force. If the paper comes out from under the heel, the test is over and measure how far the knee is past the toes.
      Hope that helps,
      Kevin

  3. Jennyct says:

    I’ve been working with a PT for post fibular fx and stiffness. I only have .25 inches from toe to wall and PT doesn’t seem to be working. If I continue stretching on my own, will it eventually improve?

    • Kevin Maggs says:

      That depends on what is causing the lack of dorsiflexion. If it is a soft tissue extensibility restriction (i.e calf muscles, Achilles, posterior ligament tightness), your range of motion should improve. On the other hand, if it is the shape of the talus (the top bone in the foot), it will not improve.

  4. Renee says:

    I chipped a piece of bone off the bottom of my tibia while playing touch. I was put in a back/half slab for a weekend until I could get a CT scan to confirm it was broken. If the half/back slab was applied incorrectly could this affect my dorsiflexion? And if so, is there any procedure you are aware of that can fix this?

    I had the back slab on for 3 days, a cast for 6 weeks. I then underwent physio for 4-5 months before seeing a specialist who operated, followed by a cast for 2 weeks and a moonboot for 3. I started physio again and I am now at the 10 month mark and still no dorsiflexion.

    • Kevin Maggs says:

      Renee,
      Sorry to hear about your ordeal. Over the internet, it’s difficult to say what would be restricting your dorsiflexion. When you try and dorsiflex, do you feel the limitation is a stretch in the soft tissues (Achilles, calf muscles) in back of the calf/ankle, or do you feel a pinching in the front of the ankle?

      • Renee says:

        My calf muscles and Achilles are extremely tight but I don’t get any sort of pain or anything, it just feels like its stuck (I don’t know how to describe it better). With my toes right against a wall, I can almost touch my knee to the wall but cant quite get there without lifting my heel off the floor. There is not much improvement after the physio massaging my calf to try and relax the muscles.

        Initially my specialist said it was due to the back slab but when they operated, the bone chip was much larger than appeared on the CT scan and he thought that perhaps I would get more movement back.

        The physio has now told me she feels that there is not much more she can do in terms of helping the dorsiflexion and recommended I take up cycling instead of trying to run again! I just thought I would try and research for any other methods or things to try.

        • Kevin Maggs says:

          Renee,
          A physio or chiro who is well versed in Mulligan mobilization and/or Active Release Technique may help, but I’m not confident that results will be fantastic. If you had adequate dorsiflexion prior to the injury, and the surgeon removed all the loose bodies (bone fragments) in the joint, you should be able to make some progress with enough time and effort. Again, this is not recommending any particular treatment, and this does not constitute a doctor/patient relationship and I’m just giving general advice and you should always consult with your physician

  5. Jeremiah Say says:

    I always have this injury whenever I play my favorite sport, Soccer! Does this mean I can no longer play my favorite sport anymore? How do I prevent this injury? I did my regular warm-up etc. but it still persist.

    • Jennifer Reyes says:

      I pla\y soccer so when i’m running my ankles sorta stay straight like they don’t bend its kinda like how penguins walk, i’m wondering if i have this

  6. Jennifer Reyes says:

    play* aha sorry

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