Got Dorsiflexion?

Poor ankle mobility can have a significant impact on motion throughout other areas of the body. If mobility is lost at the ankle joint it has to be found somewhere up the chain, such as the knee or hip. One of the most important motions at the ankle is Dorsiflexion. This is the ability to flex or move your foot toward your nose. Dorsiflexion allows us to squat, go down the stairs and even walk to protect our knee and hip joints. So, here’s the question. Do you think you have enough Dorsiflexion? 

Anatomy of the Ankle

The true ankle joint consists of the tibia, fibula and talus. The tibia is the longer and larger bone of the lower leg, known as the “shin bone”. The fibula is the smaller bone of the lower leg and is the bone on the outer portion of the lower leg. These two bones form the lower portion of the knee and come down and form a space for the talus to tightly fit into it.

The ankle joint is a synovial joint meaning that it is covered by a membrane that forms a capsule around the joint. This capsule is filled with synvoial fluid which helps make the joint mobile. Synovial fluid is a clear-like fluid that is within the joint capsule who’s main purpose is to decrease friction between cartilage and provide nutrition to the joint.

Motions of the Ankle

The ankle joint is a joint with triplanar movement, meaning that it has 3 planes of movement. These motions include:

  1. Dorsiflexion: the movement of the foot and an upward direction towards the shin. 
  2. Plantarflexion: the movement of the foot pointing the toes away from the body.

ankle dorsiflexion squat

 

3. Inversion: The motion in which the sole of the foot goes toward the midline

4. Eversion: The motion in which the sole of the foot goes away from the midline of the body.


Although the ankle joint moves in 3 planes, we are going to focus on the hinge part of this joint and the importance of Dorsiflexion.

Muscles that Contribute to Dorsiflexion

  • Tibialis Anterior
    • The Tibialis Anterior is the primary dorsiflexor. It originates on the tibia (shin bone) and then attaches to the top of the foot. When this muscle contracts it pulls the foot upwards towards the shin bone or nose. Due to the insertion point of Tibialis Anterior, it also assists in inversion of the foot.

 

 

 

The following muscles assist in performing Dorsiflexion:

  • Extensor Hallucis Longus
    • The Extensor Hallucis Longus muscle originates on the fibula and attaches to the big toe. It assist in Dorsiflexion by initiating extension of the big toe. It also assists in inversion of the foot.
  • Extensor Digitorum Longus
    • The Extensor Digitorum muscle is just behind the Tibialis Anterior and originates on both the tibia and the fibula and attaches on the top side of the last 4 toes. This muscle assists in Dorsiflexion as it extends the toes. It also assists in eversion of the foot.
  • Peroneus (Fibularis) Tertius
    • The Peroneus Teritus is the smallest of the muscles that assist with Dorsiflexion. This muscle primarily originates from the fibula and then attaches to the base of the pinky toe. This muscle also assists in eversion of the foot.

Why is Dorsiflexion Important?

Dorsiflexion is important for activities such as walking, running, squatting, lunging, weight lifting, and other daily activities. Studies have shown that a limitation in Dorsiflexion can result in other orthopedic events such as:                                                      

Meniscus tears

Knee Ligament tears

Hip injuries

Low back injuries

Ankle Sprains

 

For example, if a patient does not have enough Dorsiflexion when trying to land from a jump the knee has to compensate for this lack of mobility. When this occurs it makes the knee susceptible to ligament tears, meniscus tears and patellar tracking issues which can lead to many dysfunctions.

Additional studies have shown that a lack of Dorsiflexion can affect a person’s ability to squat correctly. Limited Dorsiflexion during a squat can cause the knees to collapse inwards (knee valgus). This changes the hips ability to facilitate the glutes to push out of the squat. This lack of glute control can then cause the back to carry the weighted load, which can result in low back injuries.

As you can see, these are perfect examples of how one area of the kinetic chain can affect another.

The Kinetic Chain

The overall concept of the kinetic chain is the idea that not one single joint area (this includes the joint itself, muscle, nerves,etc.)  works alone. Different areas of the body work together to have more effective and efficient motion, and one area can directly or indirectly affect the other. This concept is important when someone is receiving treatment. Patients should not just get evaluated for the painful area. The actual cause of pain could be coming from a different area/part of the chain, so it is important to look at the body and how it moves as a whole.

The Lunge Test for Dorsiflexion

The lunge test has been shown to be a good test to measure and retest Dorsiflexion. The great part about it- it’s simple and you can do it at home.

  1. Start in a half kneel position in front of a wall with the back leg on a pad or pillow (to protect your knee)
  2. The front foot should be 4 inches away from the wall
  3. Push knee towards the wall keeping the heel down 

        *A normal range of motion is to get the knee to the wall. *

                                       ankle dorsiflexion squat    ankle dorsiflexion squat

Exercises to Improve Dorsiflexion

Lack of Dorsiflexion range of motion can be attributed to lack of mobility, but it can also be due to a lack of muscle strength in muscles that cause this action to occur,  or tightness in the muscles that counter this motion (which would be the plantarflexors). The following exercises help address both of these restrictions.

  • Half Kneel Dorsiflexion stretch
    • This is the same position as the lunge test- it can also be used as an exercise
    • Start in a half knee position in front of a wall with the back leg on a pad or pillow
    • The front foot should be flat on the ground and 5 inches away from the wall
    • Push knee forward until a good stretch is felt in the calf
    • Hold 3-5 seconds and repeat for a total of 10 repetitions                                                     ankle dorsiflexion squat                   ankle dorsiflexion squat

 

  • Carioca with a squat
    • Step left foot over your right
    • Squat down with most of the weight through the left foot and the right foot in back for balance and on the toe (heel raised)
    • Come up from squat and step out with right leg
    • Step left foot behind right leg
    • Squat down with most of the weight through the right foot (as it is now in front) and the left foot in back for balance                                   
    • Come up from squat and step out with right leg
    • Continue for 20 feet then switch to go the other direction.

 

 

  • Modifications (if the squat hurts your knees) – Instead of a full squat do a mini-curtsy

                                           

©2018 ALL BLOG CONTENT at duncansportspt.com by Abbey Campbell, DPT


ABOUT THE AUTHOR

Abbey Campbell, DPT is a physical therapist practicing in Lafayette, CO at Duncan Sports Therapy and Wellness. Abbey is a former collegiate athlete swimmer and a new mother. She uses a whole-body, movement-based approach to heal injury and pain. Abbey is passionate about preventative care and patient education to get her patients back to happy, healthy movement.


References:

https://www.themanualtherapist.com/2012/09/the-half-kneel-ankle-df-test.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484905/

3 Comments

  1. Dave on December 12, 2018 at 8:49 AM

    Thanks for your articles, I read every one and often come back to them when issues come up as a result of training (or more likely over training!)
    I think it would be helpful to be able to expand the pictures showing how to perform the stretches so we can get a better sense of how to do them correctly.

    Thanks again,
    Dave

    • Lori Duncan DPT, MTC, CPT on December 19, 2018 at 6:25 AM

      Hi Dave,

      Thanks for reading and your response. You should be able to click on the photos and expand on your computer. NO? I can on mine so let me know. Great suggestion!

  2. Jack Croom on December 22, 2018 at 4:57 PM

    Hi Abby, I know now how limited Dorsiflexion affects other areas within the Kinetic Chain. I am so glad I found you as your diagnosis and corrective exercises had helped me to feel better and that I have felt in years. I can’t help but believe that I will be that much better on the Bike!

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