In the legend of Achilles he was dipped into the river Styx by his mother to make him
indestructible. There was a spot on his heel which wasn’t covered by the water. Later in
life he was killed by an arrow to his heel. We might not have to worry about an arrow
but if you’ve ever suffered Achilles pain or an ankle sprain you will understand the
With regular walking, your heel lands on the floor with a force of one and a half times
your body weight. Such impacts can cause microscopic damage to our ankles. Without
enough rest, these microscopic traumas can build up into an injury. Your ankle is a
hinge joint moving primarily in two directions dorsiflexion (up) and plantar flexion
(down). The muscles that move the ankle are located in the front and back of the lower
leg. With assistance from the foot, the ankle can perform inversion (turning in) and
eversion (turning out) as well. The muscles in your lower leg are attached to bones in
your feet by tendons. They control movement that allows us to stand, walk, run,
balance and jump. These muscles move your toes and control the position of your foot.
The anatomy of the ankle is formed by the meeting of three bones. The end of the
shinbone (tibia) and a small bone in the leg (fibula) meet a large bone in the foot, called
the talus, to form the ankle. The end of the shinbone forms the inner portion of the
ankle, while the end of the fibula forms the outer portion of the ankle. The hard, bony
knobs on each side of the ankle are called the malleoli. These provide stability to the
ankle joints. Ligaments on each side of the ankle provide stability by strapping the
outside with the inner portion of the ankle. Tendons that attach the large muscles of
the lower leg to the foot wrap around the ankle both from the front and behind. Your
heel bone is connected to the calf muscles in your lower leg by your Achilles tendon,
which is the most important tendon for movement.
Aging takes its toll on your feet as it does with the rest of your body. Given the amount
of stress we place on our feet over a lifetime, it’s easy to see why these problems occur.
As your feet age, connective tissues called ligaments can begin to stretch out, reducing
the height of your arch (referred to as fallen arches) and leading to a condition known
as flat feet. In addition to general wear and tear, there are physiological changes that
will inevitably affect how your joints, bones, and tendons function. These changes can
give rise to stability problems. Flat feet can alter the angle of your foot, causing
overpronation, the loss of stability, and an increased risk of ankle and foot sprains.
People who overpronate often have tight calves and a weak tibialis anterior which is the
muscle that runs down the front of the shinbone. It’s the muscle we use to tap our foot.
Another type of connective tissue, known as a tendon, can begin to lose water as you
age. Tendons connect muscle to bone, and, if these are shortened due to water loss, you
may end up with a more flat-footed gait since you will be less able to flex your ankle,
midfoot, and toes. This is especially true of the Achilles Tendon which connects the calf
muscle to the heel bone. Unless steps are taken to routinely stretch your Achilles
tendon, you may be at greater risk of a tear or rupture if you overexert the tissues with
quick movement such as when playing tennis, pickleball or running up the stairs.
That is why ankle conditioning is so important.
A sprain can easily occur when we twist or turn our ankle after a misstep. Ankle sprains are one of the most common musculoskeletal injuries. Sprains are injuries to the ligaments of the ankle, causing them to partially or completely tear as a result of sudden stretching. A sprain can occur on either or both of the inner and outer portions of the ankle joint. Ankle sprains more commonly happen when there is a preexisting muscle weakness in the ankle area or a history of previous ankle injuries. The typical injury occurs when the ankle is suddenly twisted by stepping off an uneven surface. The pain is initially severe and can be associated with a “popping” sensation. Immediate swelling over the area of injury often occurs as the injured blood vessels leak fluid into the local tissue.
Achilles tendonitis is another common ankle injury. The Achilles tendon helps to raise the heel off the ground. Achilles tendonitis and tendonosis are common when we take part in dynamic activities such as running or pickleball as it puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. The structure of the tendon is then altered, resulting in continued pain. This inflammation is typically short-lived. Over time, if not resolved, the condition may progress to a degeneration of the tendon and developing into Achilles tendonosis in which the tendon loses its organized structure and is likely to develop microscopic tears. A person with Achilles tendonitis will have a difficult time standing on tip toes. How we sleep is important as well. We often stretch out our feet when we sleep in turn shortening the Achilles. If you are dealing with a cranky Achilles it may be beneficial to lower your body down so the toes are dangling off of the bed. This may help keep the feet relaxed while sleeping allowing the Achilles to stay lengthened. There are splints you can buy for sleeping as well.
The knee jerk reaction for ankle injuries is to use tape, supports or wraps. More recently however, therapists noticed more ankle injuries and concluded that higher support may be necessary because wrapping can actually cause muscles to shutdown. It provides a false sense of security. Some studies have even shown wrapping to increase the probability of the joint being reinjured. Furthermore, tape can change the insertion point of the muscles that act on the ankle. This means that the mobility that we previously got from the ankle is now absorbed by the knee because the ankle can’t move properly. New structures are forced to compensate and absorb higher levels of force and eventually wear down. Therefore, before you use tape or wraps to treat an ankle injury talk to a medical professional to see if this is in fact the right course of treatment for you.
Our feet contain the most mechanoreceptors in the human body. Mechanoreceptors are cells that are responsible for transmitting mechanical stimuli and relaying information to our central nervous system. They give us feedback on our foot position. By not providing our feet with a consistent barefoot stimulus, we lose our ability to receive messages from those mechanoreceptors. Is it any wonder that many first-time ankle sprains occur when simply stepping off of a curve? Third-world countries have a significantly lower rate of ankle sprains. We lose feedback from our feet about changing surfaces by constantly wearing shoes. So, take your shoes off every now and again and enjoy the grass between your toes.
The ankle strategy, also called ankle sway, is used in response to small losses of balance. Like when standing on a moving bus the foot acts as a lever to maintain balance by making continuous automatic adjustments. When a small balance adjustment is needed muscles close to the floor activate first and flow upward. If your body sways forward the toes dig into the floor and the ankle, calf, and muscles on the back of your leg contract to prevent you from falling forward. If your body sways backwards the toes lift up and the muscles at the front of the lower leg as well as other muscles in the front of the body contract and prevent you from falling backwards. The ankle strategy is automatically utilized a thousand times a day in response to small losses of balance. There’s no need to think about the toes lifting or the calf muscles contracting, the central nervous system does the work automatically. If the nervous system is not getting the feedback it needs, responses can be delayed and we can fall. The more we can do to improve sensory feedback and improve flexibility and muscle strength of your supporting joints the less chance we have of slipping and falling. We need to train our body to respond to real life situations. You may have seen the Bosu at a fitness facility or at your physiotherapist. The Bosu is an excellent tool for strengthening ankles. If you’ve ever stood on a Bosu you may have noticed how incredibly weak most of our ankles really are. I always place them near a counter top so that clients can hold on when using the Bosu. Just standing or marching on a Bosu will wake up the muscles of your ankle and improve proprioception. Proprioception is our sense of body position. Improving proprioception and stability is the key to lowering your risk of falling and getting hurt. If you don’t have access to a Bosu…no problem. A simple exercise like walking on the sand with your bare feet can help to rewire the system. Or try standing on your pillow.
Mobilize the Ankle Joint
The importance of mobilizing the ankle joint can’t be understated. The ankle contains a large amount of sensory motor feedback that’s imperative to balance. To perform this movement, line the toes of one foot right up against a wall. Shift all your weight onto the back heel and attempt to push your knee over your front ankle toward the wall. As you progress, move your back foot further and further away from the wall.
Start by standing with the ball of your foot on a stair step. Next lower your heel until you feel a stretch. Hold for a three count and then lift up on to the ball of the foot working the ankle through the full range of motion. Repeat 10x.
Daily Isometric Foot Contractions
This simple exercise can really help your ankles out in the long run. As we now know, our ability to curl our feet up worsens with age. This decreased control has a negative impact on our foot’s sensory awareness. Foot isometric holds require very little effort
and can be done anywhere. To perform them just curl your toes toward the bottom of your foot and hold for ten seconds. Begin with one set of ten repetitions for ten seconds.
To prevent ankle injuries, it is very important to strengthen the tibialis anterior. This is the muscle at the front of your shin bone. If you look at the size of your calf muscle vs the anterior tibialis there is a huge difference. To create balance, remember to toe tap whenever you can. Another variation I like that is great for overpronators is to toe tap really concentrating on lifting from your baby toe. Put on some music and have some fun.
That’s the wraps on ankles!