Importance of Foot & Ankle Mobility & Stability: Ankle Sprains

The foot and ankle play a huge role in almost all functional activities and limitation can affect everything from standing and walking to being able to provide for yourself or family. 

My story: George Andrews, PT DPT 

As a child, I was very active, playing some type of sport almost year-round. I had recurrent ankle sprains/rolled ankle that were never properly rehabbed or strengthened, leading to chronic ankle instability. As I became older, I was more serious about two sports, diving and volleyball. 

By high school, I was playing volleyball year around and diving 4-5 months of the year, all the while not taking care of my ankle issues. My ankle sprains became more frequent, and in turn I gave myself less and less time to recover. By the time I was in college, I had been recruited to dive for Indiana. As a Division I athlete, my training had exponentially increased and my ankle could not keep up.  

In the spring of 2011, my ankle had become so problematic that I was unable to push through the pain. I had surgery to remove 3 loose bodies embedded in my ankle. After the surgery, my function did improve and I was sent back to my sport without any proper course of physical therapy. 

Fast forward to fall of 2020, and I am still experiencing deficits such as ankle stiffness and weakness because of my lack of formal physical therapy. 

After starting work at Dynamic Physical Therapy with my wonderful fellow PT’s, Meredith and Mary, I realized that pushing my ankle issues to the back burner while treating and educating my patients was not practicing what I preach. I decided I needed to finally do the physical therapy/sprained ankle treatment  that I missed out on years ago. My personal journey has shown me that physical therapy can be effective even years after the injury.

This blog will bring you through some common physical therapy treatments and highlight how the one–on-one care provided at Dynamic PT can help an injury that is almost 10 years old. 

Foot & Ankle Function

The foot and ankle complex is made up of 52 bones with ligaments connecting the bones together and many muscles creating movement. These structures are required to work synergistically for proper function, so you can walk down the street, go up and down stairs, adapt to uneven surfaces, cut, jump and much more!

The ankle moves in three planes of motion (transverse, frontal, and sagittal planes), and the foot has multiple joints that move in different planes. The muscles and ligaments function to control and guide these movements. In combination, these structures allow the foot and ankle to adapt to different surfaces such as rocky paths, sand, grass, and uneven sidewalks. 

You can think of pronation and supination as your foot’s ability to lift up and collapse the arch. These two motions give you balance and shock absorption during walking, running and many other functional activities. When you take a step, the foot is initially in supination for stability, but transitions to pronation to distribute the loads from the impact. You need to have good mobility and control of pronation and supination to have a functional foot. Your physical therapist can help identify any dysfunctions with supination and pronation as well as underlying causes such as deficits with coordination, weakness, or range of motion. 

Proper foot position and posture is vital for foot and ankle health. The “tripod” position of the foot on the ground yields the most engagement of the foot and ankle as well as the entire kinetic chain, including increased activation of your hip and core muscles (like your glutes and abs). The tripod position is obtained when the ball of your foot, heel and lateral side of your forefoot are all firmly planted on the ground with your toes also engaged, increasing ground contact. This greater contact with the ground will provide increased feedback to your body, making your movements more controlled. When your feet are in the tripod position, you will feel more stable and strong!

Ankle Sprains

Ankle sprains are a common injury that can cause ankle mobility and stability issues. An ankle sprain is a well-known injury that involves the strain of the ligaments that support the ankle joint. Ligaments are fibrous structures that are used throughout the body to attach one structure to another, usually bone to bone. The ankle is required to be a fairly mobile joint, to allow us to walk, run, jump, swim and everything else we do with our lower limbs. The ankle consists of seven ligaments which restrict movement of the ankle moving past what is safe for it to do so, reducing the risk of damage to the joint, and to the muscles, nerves and blood vessels that cross it. Most commonly, it is the ligaments on the outside of the ankle that are injured (a lateral ankle sprain), as the ligaments on the inside of the ankle are wider and stronger. On the outside of your ankle joint, three ligaments attach to the bony structure called your lateral malleolus. The ATFL (anterior talofibular ligament) spans forwards in the direction of your toes. The CFL (calcaneofibular ligament) joins to your heel bone directly under the malleolus. The PTFL (posterior talofibular ligament) spans towards the back of your heel. On the inside (medial) of your ankle, a larger ligament called the deltoid ligament fans out from the malleolus on the inside of your ankle to provide strong support. Sprains of all types can be separated into three grades. A grade I tear is a minor tear, and involves injury of up to 25% of the ligament’s fibres. A grade II tear is a moderate tear, involving from 25-90% of the ligament’s fibers. A grade III tear is a severe tear, involving from 90-100% of the ligament’s fibers. A grade III tear may also be referred to as a “ruptured ligament”.

Lateral ankle sprains (most common) occur when the foot rolls inward under the leg (inversion), straining the ligaments on the outside of the ankle. This can sometimes happen when walking or running over uneven ground, jumping or when changing direction suddenly. Most people have rolled their ankle throughout their lifetime, though perhaps not seriously. It’s common to think that these injuries do not require physical therapy. Physical Therapy should occur after all ankle sprains. Physical therapy is important to reduce the chances of spraining the ankle again and causing permanent ankle mobility and stability issues.

Medial ankle sprains are much less common due to the greater reinforcement on the inside of the ankle. It occurs when the ligament is stretched or strained by the foot rolling out under the leg (called eversion). They are usually caused by sudden twisting, turning, or rolling inwards of the ankle. It can occur due to a fall or stepping awkwardly onto an uneven surface or wear and tear of the deltoid ligament.

Foot and Ankle Mobility 

Mobility in the foot and ankle allows the foot to achieve its normal function without limitations by soft tissue or joint restrictions. Ankle dorsiflexion allows your body to progress over your foot during gait, go up and down stairs, and squat. Limited range of motion changes the mechanics of each one of these movements. As a result, there can be abnormal forces distributed across not only the ankle and foot, but also the hip, knee, and even low back, increasing risk of injury. 

1.  Slant board stretch 

•   Make sure heels stay down and hip are forward 
•   Hold stretch 30 seconds

2.  Knee to wall stretch

•   Entire foot engagement to ground with toes about 4-6in from wall. 
•   Drive knee towards wall with hips square to wall. 
•   Hold stretch 30 seconds

3.  Mid-foot stretch with lacrosse ball

•   Lacrosse ball under forefoot putting weight over ball as tolerated. 
•   Move ball back and forth.

Foot and Ankle Stability  

Stability and strength are highly interactive and work best when the ankle does not have mobility restrictions. The muscles of the foot and ankle work together to maintain an upright position even when outside forces are working on you. Here are some simple ways to improve the strength and stability of your foot and ankle. 

1. Eccentric Calf Raises. 

•   Begin in a standing upright position, holding onto a chair for support, with both feet on the ground.
•   Raise up onto your toes. Lift one leg off the floor, then slowly lower your heel to the floor. 
•   Repeat 10x for 2-3 sets

2.  3 Way Ankle Theraband 

•   These movements should come from the ankle with a stable leg. 
•   Move the ankle in, out and up
•   Repeat 10x for 2-3 sets

3.  Tipping Birds 

•   Stand on one leg with square hips, tip forward while being able to maintain balance
•   Return to an upright position.
•   Repeat 10x for 2-3 sets

4.  Single-leg Foam Roller Taps 

•   Place two foam rollers about 3-4 feet apart
•   Stand on one leg with full foot engagement while tapping the foam rollers with opposing hands (Right hand to left foam roller and left hand to right foam roller)
•   Repeat 10x for 2-3 sets

For more exercise ideas and videos, please check out our Instagram, YouTube or Facebook.

Physical Therapy Intervention

Physical Therapists are able to assess what is happening at your ankle and foot, whether it is a mobility, stability, strength, or movement issue and determine the underlying cause of the problem. A physical therapist will identify things to work on such as joint stiffness, muscle tightness, weakness, control/coordination, gait patterns or some combination of these factors. A specific program is developed for each individual that come through our doors. The plan may consist of many different treatments depending on your particular needs, including joint mobilization, soft tissue work, dry needling, corrective exercises, strengthening, balance and return to sport activities. 

If you are experiencing foot or ankle dysfunction, physical therapy can help! Please contact us at Dynamic Physical Therapy – Chicago. Call us at (312) 643-1555 or email [email protected] with any questions or to schedule your consultation today.