How to assess and improve ankle dorsiflexion once and for all….

www.thegotophysio.com
How To Assess And Improve Ankle
Dorsiﬂexion Once And For All
Dave O’Sullivan,
BSc (HONS) Physiotherapy,
MSc Strength And Conditioning
WWW.THEGOTOPHYSIO.COM

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Ankle Dorsiflexion is needed for walking, getting
up from a chair and stair climbing (Sidaway et al.
2012)
Decelerating, cutting, side stepping, jumping and
landing all require good DF ROM to allow the
tibia to move forward over the foot during these
movements
DF ROM occurs at the talocrural joint (TCJ). For
this movement to occur the talus must move in a
posteromedial direction and the fibula must glide
superiorly and rotate laterally (Brockett &
Chapman, 2016).

Triceps surae (Young, Nix, Wholohan, Bradhurst
& Reed, 2013)
Arthrokinematic stiffness of the talocrual (TCJ),
or subtalar joints (STJ) (Denegar et al. 2002)
Also prolonged ankle immobilisation + injuries
such as achilles tendonopathy, achilles rupture
or lateral ankle sprains (Denegar, Hertel &
Fonseca, 2002; Hertel, 2002).

Ankle Dorsiflexion Key Anatomy
Ankle joint Ligaments - Posterior Tibiotalar And Talofibular
Ligaments
Calf muscles - Soleus And Gastrocnemius
Achilles Tendon
Plantar fascia & Quadratus Plante
Shin Muscles - Tibialis Anterior
Big Toe Muscles - Flexor Hallucis Longus
Peroneus Tertius And Brevis

Ankle Dorsiflexion
Reduced Dorsiflexion associated with increased
injury risk for ACL , Achilles , and patellar tendon
injuries
Reduced DF may restrict the ability to pass the leg
forwards over the foot and to lower the centre of mass
during squat-type movements
Studies reporting increased knee valgus during squat
movements in participants with reduced DF ROM
(Mauntel et al, 2013. Bell et al. 2012)
This may be compensated for via subtalar and midfoot
Pronation or knee valgus both of which have been
linked to chronic and acute injury

Ankle Dorsiflexion
Also increase injury risk by altering lower-extremity
stiffness and landing forces…
Decreased stiffness on landing results in greater
lower-extremity joint-excursion and thereby reduces
loading rate and ground reaction forces
Decreased DF + compensations could INCREASE
GRFs or Loading Rates as the reduced joint
excursion causes increased stiffness.
Injury risked has been reported with higher GRFs and
LRs
DF restriction does not appear to reduce peak DF
angle on landing or TTP v GRF.

Ankle Dorsiflexion
Restricted DF may represent a loss of DOF and force
individuals into one of a number of alternative
movement patterns which may be associated with
various injuries.

Testing Ankle DF Range Of Motion
DF ROM measurement in closed and open-chain
positions have found significantly greater ranges such
as the standing lunge Dill et al. 2014 / Krause et al.
2011
DF ROM differs depending upon the position of the
BF during the WBLT.

Effect Of The Back Foot When Testing...
Cady et al. 2020

Tape Measure, Inclinometer or Goniometer?
Cady et al. 2020
Excellent reliability (ICC>0.94) for all
measurements in all three positions were found in
this study.
Tape measurements demonstrated higher reliability
coefficients (ICC=0.98-0.99) in comparison to
goniometer measurements (ICC =0.97-0.99) and
inclinometer measurements (0.94-0.98)
Tape measurements resulted in lower
measurement error vs inclinometer and goniometer
Goniometer measurements were found to be lower
than the inclinometer measurements but
contradicts findings from Konor et al. (2012).

Cady et al. 2020
In position 3 the influence of the BF is removed and
therefore DF ROM was found to be larger in comparison
to position 1 and 2.
Hips, knees and ankles being aligned in parallel with no
hip rotation and the standing leg heel remaining on the
ground (Kim, Kwon, Park, Jeon, & Weon, 2015).
Participants who have the strength to control the single leg
squat through their abductors and quadriceps may have
resulted in larger knee flexion therefore resulting in greater
DF (Bailey, Selfe, & Richards, 2010).
NOT an appropriate test to perform during the early stages
of rehabilitation where strength, proprioception and ROM
may be impaired.

Cady et al. 2020
Position 2 (BF heel raised off the floor) potentially reduces
the effect of triceps surae tightness or TCJ stiffness.
Most suitable to test DF ROM during the WBLT as you are
minimising the influence of any triceps surae or joint
restriction of the non-test leg on the leg you are testing.
Position 1: WBLT requires the back knee to be completely
straight which will result in both gastrocnemius and soleus
being placed under tension.
KEY MESSAGE:
DF ROM differs during all three different positions.
Standardise and declare the test method to ensure
consistency and reproducibility
Joint stiffness, triceps surae muscle tightness, hip strength
and proprioception are important considerations for test
position selection.

“What is stopping you from going further? -
The front or the back?”

Front = Consider The Posterior Ligaments
Back = Load Tolerance For The Posterior
Tissues

Front = Consider The Posterior Ligaments

Is this making sense so far?
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Ankle Dorsiﬂexion Mobility Exercises

Warning! If You Keep Losing ROM...

Next Steps...
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How to assess and improve ankle dorsiflexion once and for all….

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