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30 SECONDS OF THERAPY:  Improving Ankle Dorsiflexion

Jan 16

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Dorsiflexion is the action of raising the foot upward toward the shin. Certain exercises can help a person improve their dorsiflexion, and help recover from injury.

START

  1. Measure: Grab a goniometer or inclinometer and ensure your patient has at least 10° of dorsiflexion for optimal gait. Use Knee to Wall Test for functional assessment. (5" from the wall the patient should be able to touch their knee to the wall without lifting their heel.) 

  2. Determine LimitationMUSCULAR LENGTH (Gastroc, Soleus, other plantar flexors that need to be stretched). MUSCULAR STRENGTH (Ankle dorsiflexors that are weak?) JOINT MOBILITY (Talus, Tibia, Fibula joint restrictions)

  3. Treat: TIGHTNESS: Foam roll plantar flexors and plantar fascia in neutral and while in a functional 1/2 kneeling. STRETCH: calf stretches with knee straight/bent, wall stretches with toe extension, 1/2 kneeling stretches, ankle rocks in push up position.  STRENGTHEN: Seated ankle raises, standing ankle raises, resisted ankle raises with knee flexed and extended. MOBILIZE: AP subtalar glides in supine, standing then 1/2 kneeling. DYNAMIC: Incorporate SLS drills, eccentric strengthening, reverse bear crawls, toe evaluated squats.

STOP:  

  1. Overlooking Compensations: Be mindful of early heel rise, toe-out gait, or knee hyperextension during gait assessments, as these are red flags for limited ankle dorsiflexion.

  2. Neglecting Proximal Contributors: Avoid focusing solely on the ankle joint. Limited dorsiflexion can also contribute to balance deficits, knee pain, and pathologies up the kinetic chain.

WHY: 

  1. Injury Prevention: Limited dorsiflexion leads to plantar fasciitis, achilles tendonitis, shin splints, and patellar tendonitis, IT band syndrome, hip pain and even low back pain. So don't forget to assess ankle range of motion. 

  2. Gait Efficiency: Proper dorsiflexion is what helps the tibia move forward during gait. Without it, patients start compensating—think toe-out walking, early heel-off, or hyperextending their knees. If the patient is unable to progress the tibia forward they will find motion in different planes to maintain mobility.

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REFERENCES: 0) Paul Drumheller, MPT, OCS, SCS, CSCS The Complicated foot made simple continuED 02/28/2020 https://www.physicaltherapy.com/files/event/cont-3669-contptthecomplicatedfootmadesimple.pdf 1.) Smith MD, Lee D, Russell T, Matthews M, MacDonald D, Vicenzino B. How Much Does the Talocrural Joint Contribute to Ankle Dorsiflexion Range of Motion During the Weight-Bearing Lunge Test? A Cross-sectional Radiographic Validity Study. J Orthop Sports Phys Ther. 2019;49(12):934- 941.

2.) Awatani T, Enoki T, Morikita I. Inter-rater reliability and validity of angle measurements using smartphone applications for weight-bearing ankle dorsiflexion range of motion measurements. Phys Ther Sport. 2018;34:113-120.

3.) Awatani T, Enoki T, Morikita I. Reliability and validity of angle measurements using radiograph and smartphone applications: experimental research on protractor. J Phys Ther Sci.2017;29(10):1869- 1873.

4.) Hall EA, Docherty CL. Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test. J Sci Med Sport. 2017;20(7):618-621.

5.) Paterson KL, Clark RA, Mullins A, Bryant AL, Mentiplay BF. Predicting Dynamic Foot Function From Static Foot Posture: Comparison Between Visual Assessment, Motion Analysis, and a Commercially Available Depth Camera. J Orthop Sports Phys Ther. 2015;45(10):789-798. 1.

6.) Hsi W-L. Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus. J Formos Med Assoc. 2016;115(3):203-209.

7.) Kruger KM, Graf A, Flanagan A, et al. Segmental foot and ankle kinematic differences between rectus, planus, and cavus foot types. J Biomech. 2019;94:180-186.



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