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The most common reason people suffer from limited ankle motion is a past surgery or injury. Simple inversion ankle sprains may result in a loss of ANKLE DORSIFLEXION. This critical deficit creates compensations up and down the kinetic chain. Limited ankle dorsiflexion predisposes patients to ACL tears, MCL sprains, and knee meniscus injuries. (1)

Today’s blog will cover how to access lost ankle dorsiflexion, then provide two simple exercises to improve ankle ROM.

How do you test for Ankle dorsiflexion?

Half-Kneeling Dorsiflexion Test

Begin with your patient in a half-kneeling position so their unaffected knee is on the ground and their affected knee is bent 90 degrees with their foot flat on the ground in front of them. From this position, instruct the patient to lean forward, keeping their affected heel on the ground.  The practitioner uses a goniometer to measure the angle between the tibia’s starting and ending positions.  

The generally accepted standard range of motion for ankle dorsiflexion is 20 degrees, as defined by both the American Academy of Orthopedic Surgeons and the American Medical Association.

Pro tip: Patients who report a sensation of “pinching” in their anterior ankle during ankle dorsiflexion often have scarring of the Anterior Talofibular Ligament (ATFL). (2) Scarring is a typical result of recurrent ankle sprains.

What can you do to increase ankle dorsiflexion?

Calf Foam Rolling

(Patient instruction)

Begin in a long-sitting position on the floor with a foam roller under your affected calf. Use your arms to elevate your upper body while applying pressure to your calf on the foam roller.  Slowly rock forward and backward over tender spots with varying degrees of inward and outward position of your foot to work all areas. If you find a tender spot, maintain steady pressure on that area while you slowly flex and extend your ankle several times. Repeat as directed.

*Do not perform this exercise if you have any excessive warmth, redness, or swelling in your calf, as these signs could suggest a blood clot and warrant immediate evaluation from your doctor.  

Static Calf Stretching

(Patient instruction)

Begin standing in a split stance with your affected leg forward and toes on the wall.  Slowly lean into the wall until a stretch is felt behind the leg. To increase mobility, slowly bend your knee towards the wall for added stretch. Repeat as directed.

Static stretching is effective for improving ankle dorsiflexion. (3) Medeiros et al. found a 5-degree increase in mobility after static dorsiflexion stretches. (4) These stretches can be held for 10-30 seconds, depending on the amount of lost joint motion. Skarabot concluded that self-myofascial release and static stretching in combination resulted in more significant increases in ankle dorsiflexion range of motion as compared to either treatment on its own. (5) 

Consider prescribing static stretches and a foam roller for your next patient with limited ankle dorsiflexion (as indicated by the Half-Kneeling Dorsiflexion Test).

Every exercise & evaluation mentioned in this blog is in ChiroUp under the Clinical Skills tab. By utilizing ChiroUp, you are part of a network of like-minded providers who refuse to settle for less than exceptional.

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References
  1. Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. Phys Ther Sport. 2018 Jan;29:61-69. doi: 10.1016/j.ptsp.2017.07.003. Epub 2017 Jul 19. PMID: 28974358.
    1. van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc. 2007 Apr;15(4):465-71. doi: 10.1007/s00167-006-0275-7. Epub 2007 Jan 20. PMID: 17237964; PMCID: PMC1915597. https://pubmed.ncbi.nlm.nih.gov/17237964/
      1. Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006 Oct;40(10):870-5; discussion 875. doi: 10.1136/bjsm.2006.029348. Epub 2006 Aug 22. PMID: 16926259; PMCID: PMC2465055.
        1. Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. International journal of sports physical therapy, 10(2), 203–212.
          1. Medeiros DM, Martini TF. Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis. Foot (Edinb). 2018 Mar;34:28-35. doi: 10.1016/j.foot.2017.09.006. Epub 2017 Oct 27. PMID: 29223884.

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