Is All Ankle Dorsiflexion Created Equally

Welcome, everyone, to the next episode of the Redefining Physical Therapy Podcast. I’m your host, Dr. Scott Gray. Happy Tuesday, everyone. And so, today we’re going to hop right into talking about ankle dorsiflexion and ankle mobility, right.

So, for all you physios out there, manual therapists, improving your athletes or your clients, patients, ankle dorsiflexion is a game-changer in regards to treating basically just about anything in the body.

Obviously, it’s got to make sense clinically and biomechanically, but today I want to talk about like, is all ankle dorsiflexion really created equally.

And so, for instance, if I have someone that I’m trying to improve their ankle dorsiflexion in walking versus an Olympic lifting athlete versus maybe a football player, soccer player, are they the same?

Are the biomechanics the same?

Are they created equally?

And so, I would argue that they’re not, right.

And so, in traditional manual therapy school in principles, we’re taught of, you get a posterior glide of the talus, right, for the talocrural joint when we’re trying to facilitate that. Obviously, calf tightness and that sort of thing can limit ankle dorsiflexion.

But needless to say, let’s go ahead and just deep dive into why looking maybe at the subtalar joint or the hip is going to influence your strategy improving the ankle dorsiflexion.

So, let’s talk about ankle dorsiflexion in the terminal stance of gait, which is where most clients need the most ankle dorsiflexion. And so, when we step through in gait, we seem to forget, I think, as clinicians, that the subtalar joint is going through inversion.

That’s going to change the talus, right, position on the calcaneus, right. It’s also going to change potentially the talus in between the malleoli.

And so, it’s going to be more lateral, right.

I’m going to want to facilitate basically more ankle dorsiflexion than when my subtalar joint is inverted. And so, the way my strategy might be, is too, it’s my right ankle is say, I can take my left foot and kind of bring it forward.

So I’m in a terminal stance within also rotate my pelvis back to the right. And that’s going to cause relative inversion of my superior joint, but it’s also going to facilitate ankle dorsiflexion.

And then from there, I might just drive my pelvis forward and backward to facilitate that.

What’s great about this also is that I’m going to be getting, a big stretch across the anterior hip, but also at the calf. Right, and so from there, I can that, that poster glide, but I can also kind of facilitate it when it’s, the Tellus is going a little bit more laterally because of the inversion of the heel.

So, my strategy is going to probably change a little bit, but also you got to think too, if someone doesn’t have an adequate hip extension, they’re never going to access the ankle dorsiflexion in the gate.

And so I’m going to want, A, address the hip as well in this plant, in this area, because if my hip is tight, then I’m not going to be able to load through that calf and get that poster glide that lateral glide and the inversion of the heel.

And so I’m not really treating the ankle dorsiflexion as well. Right, and I conversely someone who’s maybe a squatter, Olympic lifter, they need probably a lot more dorsiflexion, but they’re also the dorsiflexion is created differently, right.

So in the former case, I just showed you that the hip is kind of driving the ankle dorsiflexion, right. Am I stepped through with my left foot?

I’m getting that hip extension abduction internal rotation, which is then going down the chain, and then I’m getting the in terminal stance, the dorsiflex, but an Olympic lift or they’re driving, it’s more of a knee dominant, and the tibia fibula is getting driven over the toes versus the hip going into extension with the walk, someone who’s walking.

And so also with an Olympic lifter, their foot is relatively stable and neutral, right. We don’t want typically an Olympic lifter or sportsman who’s squatting powerlifter to have their foot, protonate, or in a severe Pes cavus is, right.

It’s more of a neutral foot and stable foot, as then the tip fib is driven over the top of it. So this would be like your traditional poster guide to facilitate ankle dorsiflexion. Right, so now, if we’re working on say like, an athlete that needs to change direction.

They’re going to need all of the above, right.

They’re going to need that movement variability.

They’re going to need their ankle joint to be able to get dorsiflexion when their rear foot is an inversion, right.

They’re going to need it with their foot in neutral, but then they’re also going to need to be able to get a ton of ankle dorsiflexion when their subtalar joint is averted. And so the mechanics are going to change and your strategy’s going to change.

And so, for instance, let’s just say I’m a middle linebacker and I’m opening up and chasing sonar swing pass to the left, my right ankle is going to need a ton of ankle dorsiflexion when my foot is averted, where my hip is extending, externally rotating and abducting.

Putting them in that position and then driving that motion is going to help facilitate that.

Now, conversely, if I am, maybe crossing over my left foot over my right, for whatever reason, I’m going to need a ton of ankle dorsiflexion with my right foot inverted at the heel as I cross over.

Right, and obviously is I step and run forward. I’m going to need it relatively when my subtalar joint is in neutral. So there you have it. I think these are just some different thoughts.

I think we need to think as clinicians that are really, is all ankle dorsiflexion created equally.

I would argue.

It’s not because if you look at the subtalar joint mechanics, it’s going to change the talar’s position.

Right, and so, even though you might be working a posterior glide of the true ankle when the foot’s neutral, does that translate into function when the hip may be driving the ankle dorsiflexion or when the talars are in a relative medial or lateral position, depending on what the foot is averted or inverted.

So I hope that helps, hopefully, that helps you make some better, get some better outcomes in the clinic with your patients and athletes.