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September 22/23 TORONTO
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The ankle joint is comprised of three bones: the two bones of the lower leg, tibia and fibula and the top bone of the foot, the talus.
Talus is an interesting bone because of all the bones in the body, it is the only one without any muscle attachments. Therefore, its role is a weight bearing one. I like to think of it as something that receives the weight of the body above and distributes it down and back through the heel bone, and forward through the forefoot. The talus is an architectural keystone.
The ankle joint is a sagittal plane joint, which means it moves forward and back, but not side to side. This movement is known as dorsiflexion (when the top of the foot moves back towards the front of the leg) and plantarflexion (when the whole foot is pointed like in ballet). The three bones have some interesting relationships in these actions, which I won’t go into in detail in this post. The bones that stick out on the side of your ankle, what most people call their “ankles” are the ends of the lower leg bones (tibia, fibula). There are several tendons that wrap around the back of these bones, which keeps the tendons in place and increases their leverage. Then there is a wrapping structure covering all these tendons called the retinaculum, acting like a girdle to keep it all in.
Many clients have asked me what they can do to strengthen the ankle, as they feel they are prone to ankle sprains and frequently fall over on the outside of the ankle. That is a common and understandable conclusion; if the ankles are prone to strains or sprains, they are “weak” and need strengthening. But what exactly is there to strengthen and how do you make it stronger? Or is that really the issue at play?
Your Ankles Aren’t Weak, Your Foot is Stiff
Sprains tend to happen when the foot is twisted or angled in such a way that the body is thrown off balance. So there is a balance aspect to the necessary solution. However, as we determined above, the ankle doesn’t move side to side, so what is happening when the foot is angled sideways is a movement that occurs in the joints below the talus (called, logically, the sub-talar joints), where the talus articulates with the calcaneus (heel bone). The heel bone is a long bone that not only forms the back of your foot, but runs up under the talus and articulates with the short square bones that form the mid-foot.
If the sub-talar joints are stiff and unmoved, there will be a lack of range of motion in this side to side movement known in the foot as inversion (when the sole faces inward towards your mid-line) and eversion (when the sole of the foot points away from you). Then when you step in that way that requires this motion, your ankle is forced over, which is severely limited by the joint itself, and the tendons on the outsides of those bones. You end up driving your ankle downwards with your body weight and straining those tendons. Ouch.
Our habit of wearing shoes, and shoes with “support” which often takes the form of a stiff sole and high tops for hiking limits the ability of the joints of the foot to perform this action. A hiking boot is a great crutch for those of us who have stiff immobile feet, because they help support the ankle, but you are essentially supporting your weaknesses and not addressing the root cause of those weaknesses.
Your Tendons and Retinaculum are Creeped Out
Once you have turned over on your ankle once or twice, you may actually be prone to this injury, as the sudden stretching of those connective tissues such as the tendons and the retinaculum can create a deformation of those tissues. Unlike muscles, tendons and ligaments are not good at stretching. If they experience a sudden trauma, they can become stretched and unable to spring back, they become less supportive of the area in general.
Tendons and ligaments are unbelievably strong, so it takes a lot of force to damage them, but is more likely that the damage occurs over time, which is called creep. You could say it creeps up on you. This is like losing the elastic property in a sweater or t-shirt, the fabric sags. Again, if the foot is unable to move in the desired ways, the movements that should occur below the ankles are transferred to the ankle structures, which slowly lose their integrity over time, being forced to sustain these unnatural loads.
The Direction Your Foot Faces Should Not Depend on the Hips and Knees
The action of inversion and eversion allows the foot to accommodate a different plane on the ground beneath it (other than a flat level one) without affecting the rest of the body. So it is obvious that if the foot cannot do this, the unlevel surface you may encounter on a walk off-pavement could potentially turn your ankle, or affect the joints of the knee and hip. If the knee is straight, there is no rotational capacity, and if it is bent, there is some internal and external movement where the lower leg can change orientation relative to the upper leg bone (femur). This is very handy for things like climbing uphill on unlevel ground, or stepping up onto something like a rock or log, where the place you want to put your foot can be different to the way your hip is facing. All of these things should occur without consciousness of course; we are made to facilitate a diverse environment. However, our environment is supremely short of diverse! We are asking so little of our joints on a day-to-day basis, and then when we go weekend hiking, suddenly we call on those movements that might be so unused they are rendered unavailable.
So What Kind of Training is Best?
A restorative approach to improving the movements of the foot that would have been there had we maintained a diverse range of motion in flexible footwear can be achieved by foot mobility drills and a transition out of stiff soled footwear. You need to have the foot to be able to wear those shoes but you also need to wear those shoes to be able to have those feet, so it’s a bit of a conundrum. You can transition safely by working the muscles of your feet and legs in the studio and trying to walk off the sidewalk whenever possible, even in the city. You may need support for years to come, but working towards having these joint ranges and mobility is going to have a huge increase in the health of your foot in general, and is well worth working on.
Here are two of my favourite ankle exercises:
Your PT might have told you to perform ankle circles to increase your strength. But there’s ankle circles, and then there are my ANKLE CIRCLES! When I do them in class, most people can do only one or two, they’re so fatiguing. Do them very slowly, seated on the floor, with one leg straight out and raised on a block so that the foot is slightly elevated from the floor.
It is important to minimize the movement of the leg as much as possible! The movement should occur below the ankle!
Pull the top of the foot straight back (dorsiflex) as much as you possibly can. Hold it there for a moment and notice that the sole of the foot might be angled inwards. Hold the dorsiflexion but level the sole by pulling the baby toe side of the foot back. Then holding the dorsiflexion, start to angle the sole outward. It might help to imagine you had an eye or a beam of light on the bottom of your foot.
Now, maintain that outward eversion and start to slowly push the ball of your foot away leading with the big toe side, point as much as you can (plantarflex) while still looking outward. When you get to the bottom of the circle turn the beam straight down by sweeping the baby toe side down and away and then lead with that side of the foot to turn inward. The outside edge is as far away as you can get it, and the big toe side of the foot leads its way back up to the top of the circle. Maintain the inversion as you maximize dorsiflexion and then finally return to the top and level the sole of the foot again.
(When I do an Ankle Workshop, I teach these circles in FIVE different positions.)
Find yourself a hill. It doesn’t have to be steep. Now, you are going to walk up the hill but in a zig-zag pattern, moving sideways to the hill and up and then changing direction after a few dozen steps and in this fashion moving to the top of the hill. Now do the same thing back down. This will make one foot invert and the other evert. You are practicing mobility of the sub-talar joint and getting hip strength into the bargain. Awesome. If you are lacking this range of motion, just find a less steep hill, or climb more up and less sideways to accommodate your current abilities.
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