Top 5 Fridays! 5 Things to Address for Ankle Dorsiflexion That Are Not The Talocrural Joint | Modern Manual Therapy Blog

Top 5 Fridays! 5 Things to Address for Ankle Dorsiflexion That Are Not The Talocrural Joint


Many times, treating the painful and limited area on a patient is threatening and you will have slow to no results with treatments that normally work rapidly.

Here are 5 areas to address that would potentially improve ankle dorsiflexion other than the talocrural joint.

1) The Calcaneus
  • this is old hat to traditionally trained manual therapists, but I find myself not looking at this area as much as I should
  • occasionally with a painful loss of dorsiflexion, or with an impingement like perception at the talocrural joint, a little light IASTM around the calcaneal bony contours works wonders
  • if still limited in tri-planar rock, just wiggle it a little in various positions of ankle neutral, df, and pf and then recheck WB dorsiflexion
2) The Great Toe
  • It's an all too common pattern to see forefoot eversion during gait as a loss of dorsiflexion compensation
  • however, chicken or the egg, this is concurrent with a loss of great toe extension which is lost if no push off is occurring during gait
  • if you are able to consistently restore dorsiflexion and yet it does not stay improved (with patient compliance to HEP) - look at the great toe/first ray mobility
3) Tibial IR
  • again, the compensation of forefoot eversion often leads to consequences up the chain, and one of these is tibial ER, or a lack tibial IR
  • that's why light IASTM along the bony contours of the tibia and and lower leg anteriorly and posteriorly plus a functional mobilization of tibial IR work so well during the half kneel ankle dorsiflexion test
4) Sidegliding in Standing
  • this is my go to Repeated Motion Exam for any lower quarter presentation
  • studies show both repeated extension in lying, and P/A mobilizations to the lumbar spine both improve neurodynamics
  • since we cannot predict the loss of motor control or pain perceptions, we can only work on movement and loading asymmetries and see if they affect a distal portion peripherally
5) IASTM to anterior calcaneus
  • I find this works better to improve ROM in painful posterior presentations
  • you are still re-defining a potentially cortically smudged representation of the foot/ankle but not increasing threat by avoiding the painful area
  • about 30-60 seconds of as light IASTM as possible are all that is needed to improve df in many cases
Comments or other tips you have to share? Chime in below or on the facebook page!

Keeping it Eclectic...

6 comments:

  1. Can you post links to the studies showing that repeated extension and P/A's improve neurodynamics? It would be great to have some references for a school assignment I'm working on!
    Thanks, and have a nice weekend!

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  2. How about navicular mobility and/or midfoot eversion?

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  3. Also check prox and distal tib/fib gliding.

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  4. I will sometime today or tomorrow, I am teaching in an area with limited linternet access. The P/A study is available, I am pretty sure the repeated extension study is a student capstone project done at a local school where I used to teach in their fellowship program.

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  5. I find that midfoot eversion is often too mobile, as far as navicular mobility it can definitely be limited but in the case of a rigid arch, you are most likely not going to change it. Forefoot mobility and ability to splay in general are important for the adaptible tripod

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  6. Agreed, and when I look at tibial IR and ER, that is really just more of a gross way to look at what you are looking at arthrokinematically.

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