It Starts at the Ankle…
- Posted on: Jan 17 2019
The ankle is an important joint for all activities in the upright position. It is commonly overlooked and we always expect it to work. It is the first moveable joint that accepts force when the foot contacts the ground with walking. Problems with the ankle will cause problems up the kinetic chain. It usually starts at the ankle and will travel up to the hips, back, shoulder, and neck. To understand this process, we needed to understand the joint itself first.
The ankle is made up of 3 different bones coming together. These bones are the tibia, fibula, and the talus. The tibia and fibula are held together tightly through ligaments called the tibiofibular ligaments. A space is created at the bottom of these 2 bones coming together which is called the mortise. The talus sits in this space. The articulation of the bones forms a hinge joint that allows the foot to move upward, known as dorsiflexion, and downward, known as plantarflexion. The deltoid ligament, which is positioned on the inside aspect of the ankle, prevents the ankle from rolling outward. Three ligaments– the anterior talofibular, posterior talofibular, and calcaneofibular– prevent the ankle from rolling inward. The ligaments on the inner part of the ankle are much stronger than the ones on the outer part, which is the main reason most ankle sprains are rolled inward. Normal motion of the ankle is 20 degrees of dorsiflexion and 50 degrees of plantarflexion. Only 10 degrees of dorsiflexion and 20 degrees of plantarflexion is required for normal gait.
Problems with the kinetic chain occur when weakness, poor motion, or poor joint mobility is present. Poor joint mobility of the ankle will cause the force from the initial contact of the ground to be magnified. The force is experienced in the foot and knee first, causing repetitive microtrauma. Plantar fasciitis and patellar tendonitis can be associated with this. Poor motion at the ankle reduces the ability to generate strength with activities like running, jumping, and squatting. This causes the other joints to work harder with all athletic activities.
Limited dorsiflexion will cause gait deviations to translate the lower part of the leg forward. External rotation of the hip is a common compensation and can lead to iliotibial band tendonitis and bursitis of the hip. An external rotated hip also causes poor tracking of the knee, which leads to patellofemoral syndrome. Continued limitations of motion will cause the trunk to lean forward. The loss of neutral spine will cause back pain. As poor positioning of the back progresses, it causes improper positioning of the neck and shoulder.
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