From the NESTA Functional Training Specialist
The primary function of the ankle and foot is to absorb shock and impart thrust to the body during walking and running. The foot and ankle joints have the ability to dorsiflex, plantarflex, inert, evert, adduct and abduct. Like any joint, this increased ability to move can create stability problems. In many cases, problems that affect the ankle may affect the knee. What affects the knee often affects the hip. What affects the hip has an effect upon the spine. Get the picture? It is very unlikely that injury or dysfunction at any one joint will ONLY affect that joint. There will always be significant effect throughout the kinetic chain, and this effect will increase the longer muscular imbalances and altered joint arthrokinematics persist. Therefore, not only can dysfunction at one joint create dysfunction elsewhere (consistent ankle over-pronation can lead to knee and hip pain), pain or dysfunction may exist at one location and the problem may come from another location (shoulder pain may relate to latissimus dorsi tightness which begins at the hip as hip dysfunction from overly tight and overactive hip flexors from extended periods sitting). Time and efforts can be wasted attempting to relieve the symptom of pain and “heal” the joint where pain persists rather than determining the indirect cause of pain from dysfunction at another joint.
Perhaps the most common dysfunction at the ankle and foot is the tendency to pronate at foot strike upon the ground. This is most often observed through a “flat foot” or “disappearing arch” at the medial aspect of the foot. In many cases, orthotics may be prescribed before sufficient time is given to determine possible muscular imbalances that may be causative of “flat feet” as opposed to structural causes. It may be wise to gain the advice of at least two different therapists or specialists before choosing orthotics. Supporting a muscular or soft tissue problem with the added structural support of orthotics may create a continual dependency upon the orthotics with little opportunity to improve function. Only a qualified therapist should make this final decision after soft tissue efforts to alleviate dysfunction have been made.
With ankle pronation, upon foot strike, the ankle everts. The sole of the foot turns outward and the ankle dorsiflexes. With ankle eversion during dorsiflexion, the tibiofibular joint slides in-ward and does not track properly. This improper tracking may result in an inability to dorsiflex and plantarflex properly. The ankle is designed to dorsiflex at foot strike in order to generate sufficient length of the posterior calf musculature within the stretch shortening cycle to increase force production capabilities at push-off. In most cases, the anterior tibialis must be strengthened (dorsiflexion and inversion) and the gastrocnemius and soleus muscles must be stretched. However, if the muscles on the posterior calf are stretched and the anterior muscles not strengthened, any benefit gained from the stretching will be lost as the problem will reoccur until the tibialis muscles achieve sufficient strength to help stabilize and control movement at the ankle.
Individuals who have repeatedly broken or sprained their ankles may also suffer from repeated injury or dysfunction due to ligamentous laxity. Once the ligaments have been stretched in a particular direction following a severe or repeated injury it can be difficult to nearly impossible to correct the problem. What can be done, from the perspective of function, is to perform sufficient ankle strengthening and muscular activation exercises that emphasize weak directions of movement and target weak or inhibited musculature. Exercises for weak, commonly injured or dysfunctioning ankle joint musculature and soft tissue development will be covered later.