Weak Link : Foot and Ankle

Footwear and muscle imbalances throughout the body can have a huge influence on how well the ankle works. Being that our foot and ankle complex, are the first things to make contact to the ground that we walk, jog and run on, its function is extremely important to the message that gets sent to the rest of our parts. This article will talk about the basic anatomy of the foot, what could go wrong with it, how to find out something should be done and what to do about it.

Basic Foot Anatomy

bones and joints

The foot and ankle are made up from of a number of bones and joints. The two main joints are the true ankle joint and the subtalar joint. Both are involved in the movement of the foot. The true ankle joint helps move the foot up and down whereas the subtalar will move it left and right. It may be helpful to look at the foot in three sections, the forefoot, midfoot and hindfoot. It is the responsibility of the hind and mid foot to absorp and spread the shock, while the forefoot will adapt to the terrain and help propel the leg forward.

Image

arches

The foot is also made up of three main arches, which are formed by bones, muscles, ligaments and tendons. The medial arch is the one we see that runs on the inside part of the foot from the big toe down to the heel. Its job is take on weight with each step and absorp the shock. The lateral longitudinal arch is on the outside of the foot and it helps support the weight of the body above it. The transverse arch goes across the foot from one side to another. This arch helps to support movement of the foot and dissipates shock as well. The structure of these arches allows for the muscles above to have the correct length-tension relationship to function correctly.

muscles of foot and ankle

The muscle of the muscles that surround the ankle enable the toes to be pointed and pulled in (dorsi and plantarflexion) as well as be turned in and turned out, all while under no influence of the ground. In real life, and under the influence of gravity, these muscles act as a stirrup. Upon contact with the ground as in during, these muscle will tighten up around the foot to maintain an arch and transfer weight to the other foot. Their function is crucial to the health of the joints above them. The importance of theses muscles is in concert with that of the Achilles tendon. The Achilles tendon connects the plantarflexors to the bottom of the foot. With each step, energy is stored within the Achilles as is transferred back to the other foot.

Image

 What Happens

There are two  common problems that occur at the foot and ankle.

                                                            1.overpronation

                                                            2.lack of dorsiflexion

Overpronation is a condition that is characterized by flat feet. When a foot overpronates, it will lose its arch. This creates a situation in which the foot doesn’t absorb shock well and the rest of body must make up for it. When a foot loses it arch it will also abduct (turn out like a duck)

Lack of dorsiflexion normally accompanies an overpronated foot. A foot will lose dorsiflexion, because it abduct’s, the Achilles tendon in the back gets twisted around. When it twists, it gets restricted and when lost the ability to pull our toes up. This is especially a problem, because dorsiflexion is needed to properly allow our foot to roll through the gait cycle.

Pronation and dorsiflexion are needed because these motions act as a trigger for the rest of the muscles in the lower leg of body. For instance, a foot that doesn’t have dorsiflexion and maintain an arch, will not be able to use the soleus muscle in the calf to slow down the knee when the foot strikes the ground during gait. The knee will then compensate traveling medially, which means the gluteus maximus will be relied on more heavily. Now, with a lack of dorsiflexion the foot cannot extend back far enough during gait to properly recruit the gluteus to do its job.

The result is pain on the inside portion of the knee and in the IT band on the side of the leg.

How to Know

You can visually inspect your foot for overpronation. First, look from the side to see if you have an arch. If your foot is flat or the medial arch is very low then your overpronate. Look at soles of you shoes. If the tread looks worn more on the inside of your shoe than this more evidence. You can also look at your toes, particulary the big toe. If you big looks crooked compared to the lesser toes, this can be used as more evidence.

FOOT ABDUCTION TEST

To check for abduction, first try this little test. Grab some butcher paper and a marker. Hold on to the marker but put the paper underneath your feet. March in place for 20 seconds and when you stop DONT MOVE YOUR FEET. In stead, bend over and trace the outline of your feet, to see if they turn out or not. you could also just have a friend look take a picture of you from behind, so that you can look for to see if you can see your lesser toes. If your lesser toes are visible than this is an indication that your feet are abducting.

WALL TEST

To test for a lack of dorsiflexion, you will need a wall and some measuring tape. Set yourself up, so that your foot is about five inches from the wall. Lean forward into the wall such that you keep your heal flat on the ground as you lean.  Assess for tightness in each soleus. Watch the demonstration below.

http://youtu.be/goIw6Uky6co

What to Do

Abduction and overpronation typically accompany one another. We must base our corrective exercise approach on restoring the arch and regaining neutral foot position. This is accomplished by following our traditional treatment progression.

1.self myofascial release

2. active isolated stretching

3. integrated movement/strengthening

Self Myofascial Release

There are many different ways to perform self myofascial release, but for the foot and ankle you will need 2 tools that you should be able to find at home. A golf ball, a tennis ball and your knee is all that we need.

We start by rolling the bottom of the foot with the golf ball. Try to position the ball right under the big toe. This will help release the insertion point of the Achilles tendon. Find a sore spot on the bottom of the foot and hold it for a minute. If you can tolerate the pain or you have adapted, try pulling your toes upward.

Next, you go lie on your back to release the Gastrocnemius and Soleus muscles.  All you will do is place the belly of your calf on knee and apply downward pressure. Scan your calf for an area that is sensitive and hold for a minute. At this point, you can try rolling your ankle as well pointing your toes to increase the intensity.

Our final position is on the side of your lower leg. We address the Peroneal muscle with a tennis ball to the lower leg. Try holding this for about a minute or until you feel a release. Take a look at the video below for demonstration on all each technique.

http://youtu.be/sdYOAnIzugY

The results of your wall assessment will really kind of dictate just how much SMR you need but I traditionally recommend it daily. Particularly if you noted a big difference in the tightness of each ankle during the wall test.

Stretching

For the foot and ankle we will start with a toe and calf stretch against the wall. Try to get you heel as close to the wall as possible and arch your foot into it as you lean your body over your foot. Hold for a minute

Next we go seated on the floor with a stretch band or towel. Just wrap it around your foot and pull for three seconds and release for one. Do this for 15-20 reps, with a second between each rep. Take a look at the video below for demonstration.

http://youtu.be/tv1LgznZIrU

Integrated Movement

Our last drill is a mobilizer. We get you on your feet and mobilize your foot in three different planes to get you ready for physical activity. Try standing against a wall with one foot lifted on the ground. Start by receaching that leg forward and backward, letting the opposite feel its way through the motion. Next you will go to the frontal plane and sweep your leg across. Finally you will end in the transverse plane and rotate your leg around your body. Do each position for about 20 reps. Take a look at the demonstration below.

http://youtu.be/UNyAkEuuolQ

Footwear

Feet and ankle deviations normally take a long time to fix. The problem is that we use them so much, it becomes hard to not have interference on progress. One thing you can try to do is take a look at your footwear. If your wall test showed you that you are lacking dorsiflexion, than you should not be wearing high heels what so ever. This lack of dorsiflexion occurs because the Achilles gets all tangled up behind as a result of the abducted foot. No high heels also means that “running” shoes should be limited or avoided. If you take a look at the sole of a running shoe you will notice a 3 to 5 inch rise from the toe position. Essentially this makes the plantar flexors work overtime, and pull the foot outward.

hope this helps,

Jeremy

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