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