Ankle fractures and ankle sprains can have a large impact on the way we move if not treated and rehabilitated properly. A key component of treating this injury is to restore range of dorsiflexion at the ankle following injury as the consequences of not doing so can be far reaching.
What is dorsiflexion at the ankle ?
Dorsiflexion of foot is the movement at the ankle joint (talocrural joint) where the foot pulls upwards towards the shin and reducing the angle between the foot and the leg .
Plantar flexion is the opposite where the foot points away from the shin as if you were to go on your tip toes.
You should be able to achieve have at least 15 degrees of dorsiflexion to be within normal limits.
Why is dorsiflexion important after ankle sprain ?
The ability to dorsiflex the ankle is important in allowing the following actions:
- Stops us tripping over by allowing for the foot to clear the ground when walking.
- Gives us enough range of motion to go downstairs and walk uphill.
- Good dorsiflexion is essential in the ability to suddenly cut and change direction in sport.
- Strong relationship with dynamic and static balance and as a result prevention of falling.
- Ability to squat efficiently which affects everything from getting out of a chair to weightlifting.
- Jumping and landing techniques are also affected by stiff dorsiflexion.
Lack of Dorsiflexion following ankle sprain or fracture is thought to contribute to other injuries
Reduced ankle dorsiflexion is also a risk factor for a myriad of other injuries.
These include:
- Plantar fasciitis (Riddle et al., 2003)
- Ankle sprains in the unaffected or affected limb.
- Patellar tendon injury (Malliaris, Cook & Kent, 2006)
- ACL injury (Fong et al., 2011)
- Patello-femoral pain syndrome (Halabchi, Mazaheri & Seif-Barghi, 2013)
Stiff ankle is also associated with muscle strength at the ankle and foot.
Interestingly limited range of motion with dorsiflexion is also associated with weakness in the strength of the muscles that help pull the foot up , dorsi flexion, and also the small intrinsic foot muscles that help with fine balance, agility and move the toes.
The dorsiflexors:
When walking and running the dorsiflexors allow us to pull the front of the foot up towards the shin when we are swinging the leg through.
This is also an important quality when we need to change direction suddenly such as cutting left or right in football or court sports.
Intrinsic foot muscles and stiff ankles.
These muscles also tend to be weaker in this with reduced ankle range of motion. These muscles are very important in helping push the body forwards when walking, providing a stable platform to stand on.
They are as also integral in our single leg static and dynamic balance, this essential in the prevention of falling.
(For more info on the intrinsic foot muscles check out this post with exercises.)
How do I know if my ankle dorsiflexion is stiff ?
The simplest test that we use in the clinic is the knee to wall test, its also very easy to do at home so you can keep track of your progress.
Ideally we want the left and right ankle to be equal and greater than 8-9 cm.
See the video below on how to easily perform this at home
Top tips to get the ankle moving again:
Here are our top exercises to improve your dorsiflexion range.
Any issues with ankle pain or balance feel free to give us a call
Cheers
Dave
