If I had a dollar — scratch that, just a dime — for every time I have heard a patient,…
Unless you’ve ever suffered an ankle injury, you probably haven’t given much thought to how your ankles move. What you might not realize is that nearly all lower body movements — including walking, squatting and deadlifting — require ankle mobility.
Furthermore, stiff ankles can contribute to pain and injury in the knees, hips and lower back, because limited ankle mobility often results in compensation and compression in the joints above it.
I’m going to discuss how to identify and address ankle mobility issues, but before we go there, it helps to know a little more about the anatomy of this area.
In its simplest definition, the ankle is a hinge joint where the foot and lower leg meet. It is comprised of the lower part of the tibia and fibula, which are the two bones in the lower leg, and a bone in the foot called the talus.
The muscles of the lower leg travel across the ankle and connect into the foot, allowing for the ankle to move when they contract.
The primary actions of the ankle are plantar flexion and dorsiflexion. Plantar flexion occurs when pointing the foot down like a ballerina. Dorsiflexion occurs when flexing the foot up, as if you were pulling your toes towards your nose. Range of motion is up to 50 degrees for plantar flexion, and up to 20 degrees for dorsiflexion.
The muscles located primarily on the back of the lower leg, which are sometimes collectively referred to as the calf, are responsible for plantar flexion. They include the gastrocnemius, soleus, plantaris, flexor hallucis longus, flexor digitorum longus, tibialis posterior, peroneus longus and peroneus brevis.
The muscles located towards the front of the lower leg are the ones responsible for dorsiflexion and consist of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.
It is also worth noting that the muscles of the lower leg also play a role in inversion and eversion, although these movements don’t occur in the ankle joint itself. Inversion is more commonly explained as the foot and ankle rolling out, whereas eversion is the opposite, with the foot and ankle rolling in. When ankle mobility is an issue, the ability to control or move through inversion or eversion also needs to be considered.
I described plantar and dorsiflexion as pointing and flexing the foot, but when we talk about functional ankle mobility, we are usually referring to how the ankle moves when the foot is connected to or pushing off the ground.
For example, plantar flexion occurs when you roll onto your toes during a calf raise. Conversely, dorsiflexion happens when you lower your heels during the downward motion (the eccentric portion) of a calf raise or when you lower into a squat. Additionally, your ankle goes through plantar and dorsiflexion every time you take a step.
Ankle mobility can be limited in one or both directions. While you want to have good movement in both directions, limitations in dorsiflexion are usually the initial concern, because of its correlation with ankle and knee injuries.
In a 2011 study published in the Journal of Athletic Training, researchers tested passive range of motion in dorsiflexion on 35 healthy individuals and then analyzed their knee displacement and forces through the joints after jumping off a box. They found that those who had greater dorsiflexion experienced less impact through their joints upon landing, suggesting a correlation between ankle mobility and the risk of injury .
Limited ankle mobility can be caused by a number of factors including genetics and restriction in the soft tissues or bones, which should only be assessed by a medical professional.
However, for many of us, ankle mobility issues stem mainly from how we use our bodies day to day. Wearing heeled shoes and primarily walking on flat, level surfaces can reduce ankle mobility particularly in dorsiflexion, because we aren’t moving our ankles through their full range of motion, which in turn creates shortness in the calf muscles.
Additionally, weakness in the muscles of the lower leg can limit ankle mobility, because it is believed that the nervous systems creates, as a form of protection, a feeling of tightness around joints that it perceives unstable .
To get a clinical assessment of your ankle — which is out of the scope of a fitness professional — you’ll need to consult a medical professional. However, the weight bearing lunge has been found to be a reliable way to measure dorsiflexion and in turn give you some information about the differences between your two sides as well as potential limitations that can require further investigation .
To perform the weight bearing lunge, come to a kneeling position facing a wall, with your shoes off. Bring the leg that you’re testing forward with the foot parallel, keeping your big toe 3 to 5 inches away from the wall, depending on your height.
From there, shift your weight forward as you try to touch your knee cap to the wall, while keeping your heel connected to the ground. You also want to be mindful that your foot doesn’t roll excessively in or turn out, both of which are ways that the body might use to compensate for limited dorsiflexion. If you can’t get your knee to the wall without compensation, then your dorsiflexion is probably restricted on that side.
It is also worth noting that tight hip flexors can create the illusion of limited dorsiflexion in this test, because the back leg can stop you from leaning forward. If you feel the limitation coming primarily from the back leg, perform the same test in a standing position with the tested foot propped on a chair in front of you.
There are additional signs, during movement, which suggest limited ankle mobility:
While none of these indicators are a reason to panic, they are worth addressing. Good ankle mobility promotes better strength training technique, more power when lifting and running, and a decreased risk of pain and injury, especially as you get older.
There are several ways to address ankle mobility, depending on the underlying cause of the restriction.
Structural limitations including bony or more severe soft tissue restrictions may require hands-on treatment from a physical therapist or massage therapist. It is recommended that you consult a medical professional for diagnosis and treatment if you suspect an injury or are experiencing pain or swelling.
If your limitations are minor and you don’t feel pain, then gentle stretching, foam rolling, mobility and strength exercises targeting the lower leg can be used to help yourself or your clients improve ankle mobility and control.
If you are performing these exercises as part of a warm-up, you may want to favor foam rolling over static stretching, as the latter has been correlated with a decrease in force and power if performed prior to the activity.
Researchers from Memorial University in Newfoundland, Canada compared the effects of static calf stretching and self-massaging the calf muscles with a roller on ankle mobility. They found that while both methods improved range of motion in the ankle up to 10 minutes after the intervention was performed, self-massage with a roller led to significantly greater force production relative to static stretching .
From an application perspective, this suggests that you could use foam rolling as a way to temporarily increase ankle range of motion and then use ankle mobility and strength exercises to train the body to use that new range of motion during movement.
If you notice that your client is showing signs of limited ankle mobility or they mention ankle stiffness, how can you help them?
For general stiffness or difficulty moving through the ankles during exercises like squats and lunges, it may be beneficial to incorporate some foam rolling and ankle mobility and strength exercises like the ones above into their warm-up. You can also suggest an exercise or two for your client to do at home, since improving mobility takes consistent practice and time.
If your client doesn’t see much improvement, has significant restrictions or is experiencing pain, then they may benefit from massage or physical therapy. In these cases, be sure to refer your client to an appropriate medical professional. Remember that, as a fitness professional, hands-on manipulation, as well as pain diagnosis and treatment, are out of your scope of practice.