Top 5 Fridays! 5 Ankle Patterns

A recent study showed the effects of manual therapy to the ankle improved balance activities. Here are 5 common ankle patterns I see and treat across a myriad of conditions.

I thought I would go old school pathoanatomic and take a look at some arthrokinematic patterns that I still find useful now and then. Here are 5 Common Dysfunctional Ankle Patterns.

1) Active and passive dorsiflexion is accompanied by excessive eversion

initially I was taught to measure ankle df passively with the forefoot in slight supination to mimic gait by Dr. Patla from St. Augustine

this prevents the newbie mistake of actively and passively measuring dorsiflexion and letting the forefoot excessively evert and pronate, which is a movement of compensation
sometimes this is motor control, more often than not it's restrictions in the talocrural joint accompanied by genu valgus with closed chain activities
make sure to check not only posterior glide of the talus, but more specifically medial posterior glide of the talus
have the patient perform a MWM while you are holding the talus still as the tibia glides anteriorly over it during a lunge or squat
bias pressure toward the medial side of the talus and make sure their forefoot is not everted greater than 5 degrees

2) Recurrent lateral ankle sprains have a neurodynamic component

remember to check neurodynamic mobility in problems that appear to be chronic and otherwise seem to have good ROM
a chronically painful lateral ankle often has positive peroneal or saphenous nerve biased test

3) Loss of tibial IR

chicken or egg, pattern #1 from this post often causes tibial ER with closed chain activities resulting in a loss of tibial IR
not coincidentally, I'm sure, is this is also a common pattern in your "PFS" otherwise known as knee pain

4) Loss of fibular head anterior glide

with true ankle dysfunction, or slow responders, you need to mobilize and manipulate quite a bit more for the eventual improvements in ROM
it definitely helps to have distal areas to work on that may be much less threatening than working on the proximal DP

5) Restrictions along the lateral thigh and lateral lower leg

there is often increased tone in the lateral tibial bony contours to the proximal lateral calf, as well as the lateral thigh
I don't pretend I'm releasing these "muscles" only changing tone through a myriad of plausible mechanisms
working on these patterns, however, often improves tibial IR, thus improving ankle df

Just for good measure, he is my video on Eclectic Strategies for Improving Ankle Mobility