Kinetic Hygiene: Ankle/Foot Summary

Author: Dr. Zak Gabor 

Introduction

We will see over the next few weeks, that by following the joint by joint approach, there are ways that we can absolutely improve out joint health and orthopedic longevity, via intelligent considerations. Let’s get started.

Ankle Joint

This week we focused on the implications of ankle joint mobility/great toe mobility, as well as the implications of stability through the joints down stream. Let’s get a little more nerdy and understand further some of the anatomy as a foundation.

Image 1 left Image 2 right

 

Ankle (Talo-Crurual) joint: This is a joint that craves mobility. It is essentially a mortise that is formed by the talus (bottom part) going into the tibia/fibula “socket.” In its purest form the TC jt performs dorsiflexion and plantarflexion. What folks generally tend to lack is ability to dorsiflex (ability to flex upwards/point your ankle up towards ceiling), and there is a lot of literature that supports that decreased ankle dorsiflexion is associated with increased chance of injuries, such as:

  • -Plantar Fasciitis
  • -Achilles tendinopathy
  • -Patello-Femoral pain syndrome (PFPS)
  • -Patellar Tendinopathy

Let Us Try and Understand Why

In its simplest form, we have a desirable amount of range of motion at each joint. For the ankle, we want roughly 10-20 degrees of dorsiflexion.

 

When we have this amount accessible, our kinetic chain is able to appropriately absorb ground reaction force (GRF) and dissipate it accordingly.

Image 3 left Image 4 right

 

When we do not have this ROM accessible, the GRF has to go somewhere. What we end up seeing is an inappropriate use of other joints and muscles to compensate and hence potential increase in risk of injury. We will dive further into this when we discuss pronation and supination later on.

 

(*Side note: In the clinical setting we are taught in school to measure ankle dorsiflexion ROM in open chain, however, I have found closed chain measurements such as the 1/2 kneel test to be not only more reliable, but also more valid, with better carry over to function.*)

 

WHAT CAN WE DO ABOUT IT?

One thing we can do which is extremely effective and simple is dose daily bouts of ankle mobility through the 1/2 kneeling ankle mobilization. See post below for further instructions on how to do so.

 

Great Toe Joint

Moving forward, and continuing to discuss joints that crave mobility, lets talk about the big toe or the Metatarsal Phalangeal joint (MTP jt). This joint to me is essentially a “mini ankle” and has very similar properties, expressing both dorsiflexion and plantarflexion as its main movements, however much more ROM is available. For normal gait, we want about 65 degrees of dorsiflexion, for running we need upwards of 90 degrees! You can imagine that similar to the ankle, when we lack ROM of this joint into dorsiflexion, we inappropriately absorb GRF and these forces have to go somewhere!

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(*Side note: most common pathology we see associated with lack of great toe dorsiflexion is plantar fasciitis because of its intricate association with the Windlass Mechanism. For more on that, see contributor Tom Walters recent post @RehabScience Instagram page.)

 

One thing we can do to mobilize and improve our great toe dorsiflexion (extension) is to perform a self mobilization and follow it up with range of motion into extension, see below for further details.

 

 

 

Mid-Foot Considerations

Now we have covered the two primary joints in the foot/ankle that crave mobility, let us take a look at the intricate mid-foot, and understand why we need stability through these joints, as well as discussing the implications of pronation and supination, and whats probably overkill in certain instances.

 

Joe Gambino did a great job of covering “tripod foot” or the popularized Janda’s “Short Foot.” Basically, imagine three landmarks on the bottom of your foot: ball of your 1st toe, ball of your 5th toe, and the ball of your heel. Now imagine sucking up, or “doming.” at these points to create a muscle contraction. This is in essence, creating a short foot, or a “stable foot.”

 

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One important concept I want you to understand is that we often times need a stable base to have a more potent ability to express mobility or power up the chain. For example a stable scapula thoracic region for improved pressing strength. Similar concept here. If we can apply a stable foot, we can create a much more powerful position to propel from. Could you build a house on quick sand? Check out Joe’s contribution below as he demonstrates on video how to create this “short foot.”

 

 

 

 

Teddy Willsey did an excellent job covering the difference between pronation and supination. Essentially, these movements are a combination of all three planes of motion and are very important for gait. Yet can be quite complex. See post below for excellent picture as well as explanation.

 

To reiterate: pronation is a combination of abduction, dorsiflexion, and eversion. Pronation plays a big role in absorption of GRF but can be a problem when we over pronate and don’t properly absorb and see stress going up through the kinetic chain. Remember above how we discussed lack of ankle dorsiflexion with decreased absorption efficiency? Well here is one potential mechanism. If we lack ankle dorsiflexion, we will ultimately get more forefoot collapse via more foot abduction paired with eversion, creating a lot of stress for foot intrinsics and sub optimal forces entering the kinetic chain.

 

(*Side note: We tend to see more MEDIAL stress associated with over pronation such as: medial tibial stress syndrome, posterior tib muscle pathology, shin splints, etc.)

 

Often times you will here how MDs or healthcare pros call out patients for having “flat feet.” I tend to think this is an over stated and a “fear mongering” expression that leaves patients/athletes constantly confused about what is right or wrong in terms of orthotics, etc. In my humble opinion, train the intrinsic muscles of your feet and learn how to control your pronation, there your built in orthotics right there.

 

Supination is a combination of adduction, plantarflexion, and inversion. This is used for pushing off during gait and propelling. This is associated with a rigid foot and STABILITY. This “supination” is essentially what we are going for when we create a short foot, or try to prevent the valgus collapse of the kinetic chain (lower extremity). We do not generally see as many over supinators as we do over pronators, but they do exist. Expect to see limited ankle dorsiflexion, and potentially some over use injuries associated with great toe as well as calf complex.

 

(*Side note: We tend to see more LATERAL stress associated with over supinators such as: Cuboid pain syndromes, peroneal/fibular tendon pathologies, IT Band syndrome.)

 

CONCLUSION

If you have made it through this article, congratulations, we got pretty nerdy there. However lets summarize the KEY TAKEAWAYS from this weeks posts on daily things we can do to improve ankle/foot health.

-Check your ankles and see their ability to dorsiflex, apply 1/2 kneel self mobilization as needed.

-Check your great toe for ability to dorsiflex (extend), apply self mobilization as needed.

-Do you over pronate? Learn how to create a more stable foot through isometric “short foot” contractions

-Do you over supinate? Well for the few people out there who this might be the case: if it problematic seek a skilled health care provider to help you

 

As always, thanks for reading!

 

Content References
over pronation and medial tibial stress-
over pronation and plantar fasciitis-
patellar tendinitis and decreased ankle mobility –
Patellar pathology and achilles pathology associated with decreased ankle dorsiflexion
Image references
Mortise picture (1)-
Anatomy of TCJ (2)-
GRF (3)-
Newton Quote(4) –
Great toe (5) –
Jandas short foot (6)-
Tripod foot (7)-