Contents

Weak Ankles

Weak Ankle Treatment

Proper weak ankle treatment can get you back to the activities you love most. Rather than being limited in what you can do because of weak ankles, the following treatment options will help you to get back to better health.

Immediate Relief

  • Tuli’s3/4 Gaitors™ – Light-weight ultra-thin carbon fiber orthotic encourages proper gait, and reduces stress by guiding proper alignment of the heel and ankle. It delivers shock absorption and superior support, and can be worn in all shoes.
  • Tuli’s® DiamondBacks – DiamondBacks have a unique design that offers the user comfort and support for the arch in order to eliminate pain and weakness in the ankles. They can be worn in dress shoes, making them perfect for the office.
  • Cho-Pat® Dynamic Ankle Compression Sleeve – These provide the perfect amount of support to the ankle, allowing you enough mobility while the tendons heal. This product helps alleviate pain caused by
    tendonitis, ligament weakness, instability, arthritis, and overuse syndromes. It stabilizes and provides support to the ankle tendons and ligaments, and promotes circulation and warmth which enhances healing.

Long-Term Healing

  • ProStretch Plus™ – The ProStretch Plus™ is a tool that you can take with you anywhere you go. If you have a few minutes at work and you are feeling the weakness in your ankles, pull it out and do some stretching and strengthening exercises. Flexibility and strength of the calf and plantar fasciia are critical to ankle performance. This product is proven effective to provide a deep, gradual stretch that increases flexibility. The ProStretch Plus is biomechanically engineered to enable a controlled and targeted stretch, and is preferred by athletes, trainers, and physical therapists for over 20 years.
  • Tuli’s® Cheetahs – These are perfect for the athlete that puts incredible amounts of pressure on their feet and ankles. Most commonly, gymnasts and dancers can feel a lot of weakness in the ankles, but Cheetahs allow for more support while performing, as well as off the stage.

Chronic Ankle Instability

Ankle instability happens when the outside part of the ankle constantly “gives out” when putting weight it, especially when you’re running or walking on uneven surfaces. It can even happen when you’re standing. People with ankle instability often complain that the ankle feels wobbly or unstable. Because the condition is reoccurring, it is also known as chronic ankle instability.

What is the Cause?

Chronic ankle instability is usually caused by an ankle sprain that has not healed properly. During a sprain, the ligaments in your ankle may have been stretched or torn, and when they healed it resulted in weaker and “stretched out” ligaments. Individuals who participate in activities that involve the ankle, such as ballet and gymnastics or high-intensity sports like basketball or football, are at higher risk for chronic ankle instability. Those who suffer from repeated ankle sprains are also at risk for ankle instability.

What does it feel like? What are the symptoms?

A common symptom of ankle instability is the feeling of the ankle ready to give way. This may be heightened when walking on uneven ground or when wearing high heels. The instability may also be accompanied by pain on the outside of the ankle. Sometimes this pain is intense, and other times it may be a dull ache. Some patients also experience tenderness to the touch, stiffness, and swelling. You may occasionally “tweak” your ankle from mild activities like walking. By taking a close look at how you are walking and taking your steps, you may also notice that your ankle tends to roll or lean towards one side. Though this may be due to under or over-pronation, it can also be due to the weak ligaments surrounding your ankle. People with chronically unstable ankles will often complain of sore ankles after working out.

What is the Treatment?

Unless your ankle is severely injured, your ankle may benefit from some things you can do at home. As difficult as it is to hear, R.I.C.E. is recommended whenever you feel any onset of pain or soreness in your ankle. R.I.C.E. stands for rest, ice, compress and elevate.

Rest

Rest. Rest may be one of the most difficult things to do as it is difficult for many people to take a break from the activities they enjoy doing. However, rest gives your body time to recover and let the ligaments have a break in terms of supporting your body. If your ankles are sore, take a few days off. If there is mild to moderate pain, it may be beneficial to take a week or two off.

Ice

Cold therapy is a form of pain relief for many injuries. By applying a cold compress or ice pack to your ankle for 10 minutes at a time 2-3x a day, you will be able to help reduce any swelling or inflammation which can lead to pain relief.

Compress

Compression is important as it helps prevent swelling in the area. Try wrapping the ankle with the elastic wrap or do double-duty by using a compression ice wrap that both compresses and applies cold therapy like the DuraSoft Ankle Ice Wrap.

Anti-Inflammatory

Anti-inflammatory medications such as ibuprofen or aspirin are often taken if the patient is experiencing pain, tenderness or swelling.

Increase Flexibility and Strengthen

By increasing the flexibility in your ankle and strengthening it, you can improve your ankle. Do exercises that help with increasing range of motion, improving balance, and strengthening the surrounding muscles. Every day, work on tracing the letters of the alphabet with your foot, making small to large circles inwards and outwards, stand on one foot to improve balance, to increase difficulty, stand on one foot on a balance ball or bosu ball, and strengthen with an elastic band.

Protect

If you feel the instability daily through walking or standing, wearing an ankle brace can help support your weak ankles. The Trizone Ankle Sleeve is recommended for daily use. If you are looking to stay active and play sports, we recommend an ankle brace that provides moderate protection. Use the DonJoy Stabilizing Ankle Brace or Aircast A60 for protection during sports. These can help steady your ankle as you walk and they may also prevent additional ankle sprains that lead to chronic ankle instability. In severe cases, a custom-made orthosis may be suggested.

If the above steps do not work, your physician may suggest surgery to repair the damaged ligaments in your ankle. Surgery is usually a last resort for ankle instability, so contact your doctor to see which is the best treatment for your injury.

SUPPORT & PROTECTION FOR ANKLE INSTABILITY

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How Weak Ankles and Ankle Mobility Affect the Rest of Your Body

As much as we love to target specific areas of our body during workouts (hey there, abs and booty), it’s worth remembering that your body isn’t a bunch of separate sections. Like that giant Jenga set at your fave bar, everything is connected. While you can pull out a piece here and there, the tower won’t stand (or withstand a drunken table bump) if it isn’t solid.

In case you couldn’t tell, that Jenga tower is your body. And guess what’s the base? Your feet and ankles. (Mind-blowing, we know.) Mess with those babies, and you can bet it’s all going to be crumbling down.

“Your body is a kinetic chain,” says Jason Barone, regional clinical director at Professional Physical Therapy in Wilton, CT. Everything works together to create movement. Why that matters: Having issues in one spot can cause other things to go awry.

“If you have very weak and unstable ankles, that can make you more susceptible to a knee injury, to a hip injury-it can even lead to problems with your low back,” he says. If weak or immobile ankles are affecting your walking or running gait, over time that repetition is likely to cause one issue or another, whether it’s chronic tendonitis (like runner’s knee), hip bursitis (inflammation of the bursa, which acts as a cushion for the outside of your hip bone), or IT band issues, says Barone. The biggest ankle issues boil down to two major problems: 1) lack of ankle mobility, and 2) weak ankles. It’s ideal to have a balance between ankle strength and flexibility, says Barone-just like with all your muscles. But über-busy schedules, footwear, injuries, and natural anatomy can make it tough to maintain that balance without making an effort.

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1. Poor Ankle Mobility

How many times have you dashed out the door for a HIIT workout or a quick run around the neighborhood without a proper warm-up? Then then immediately return to hop in the shower, eat, and speed off to work or another commitment, without a proper cool-down stretch? If that do-and-dash workout sounds familiar, there’s a good chance you have tight calves, which translates to limited ankle mobility. “If you’re always strengthening and never stretching, that’s going to be problematic,” says Barone. (Try this total-body mobility workout to keep you injury-free for life.)

“The most common issue I see as a personal trainer is the lack of ankle mobility, particularly when trying to flex the feet,” says Jonathan Jordan, a Tier 3+ personal trainer and group fitness instructor at Equinox in San Francisco. “When you lack sufficient range of motion, the body figures out other ways to get the job done,” he says, even if that means causing other issues down the line.

For example, proper ankle mobility is necessary to do a squat with good form. Tight calves and heel cords (the Achilles tendon, or the tendons that run from the heel bone to the calf muscles) might cause your heels to pop up during squats, which “can cause pain and damage to your knees, disengage your glutes, and, practically speaking, you’re likely to fall down,” says Jordan.

Here’s Jordan’s go-to drill for testing ankle mobility: Start in a half-kneeling lunge with the front toes about five inches away from a wall. Gently reach knee forward knee toward the wall. See how close you can get to the wall without letting your heel pop up. If you can’t reach the wall, you’d benefit from working on your ankle mobility. (Be sure to test both sides.)

Your Remedy

  1. Warm up and cool-down: For starters, make sure you’re warming up and cooling down pre- and post-workout. Try a five-minute dynamic warm-up and a few minutes of stretching afterward (like this head-to-toe cool-down), says Barone.
  2. Spend time stretching: Twice each week, dedicate 15 minutes to some total-body stretching, allowing 30 seconds for each stretch to really lengthen the muscles, he says.
  3. Foam roll: Jordan also recommends foam rolling calves for 90 seconds to two minutes, working up and down the muscle as well as rocking side to side. “This will help reduce tension in the calf muscles and minimize pulling on the ankle joint from the Achilles tendon,” he says.
  4. Ditch the heels: If you’re an avid high-heel-wearer, you might want to consider swapping for flats or sneaks (like these sneakers that are cute enough to wear to work or happy hour). If you want the inches under your feet, at least be sure to stretch your calves post-wear: “Wearing high heels will cause tight heel cords and calves, really limiting ankle mobility,” says Barone. (BTW, high heels aren’t the only accessories hurting your body.)

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2. Wobbly, Weak Ankles

Weak ankles are super common, says Jordan, “meaning the muscles, attachments, and connective tissues around the ankles are weak or lengthened, which can lead to ‘wobbly’ or ‘flimsy’ feet.” This can be a result of genetics or a past injury (like straining or spraining your ankle). “You have to think of the ligaments around the ankle as a kind of rubber band,” says Barone. “If you overstretch that rubber band, it may never go back to the way it was before.”

Usually, people with weak ankles can tell because they lack proper support and usually suffer from poor balance and frequent injuries, says Jordan. Not only do those injuries (even minor ones) mean time away from the gym, but they also may encourage improper movement patterns. “Our bodies are amazing at doing whatever we ask it to do,” says Jordan. “It will always try and find strength wherever it can to produce the movement you are requesting of it-and it’s not always pretty.” (Here: more common bone and joint problems or active women.)

If you find yourself rolling your ankle often or feel unstable on uneven surfaces, you may have weak ankles, says Barone. If you have an acute injury or are in pain for more than a week, you should always go see a professional, he says-but if you think you lack general ankle stability, you can do some of these move to strengthen the joints.

Your Remedy

  1. Ankle letters: This is the perfect multitasking activity for solo Netflix and chilling. Sit in a chair and imagine you are writing the entire alphabet from A to Z with your feet, making each letter as sharp, pronounced, and large as possible, says Jordan. “This helps mobilize the talocrural and other joints of the foot,” he says, and it’s great for after foam rolling.
  2. Ankle gliding: Grab a resistance band and tie it around a table leg, pole, or other anchor, making a loop. Stretch the loop until there’s tension and place one foot inside, the band looped right around the ankle joint. “Be sure it fits snugly underneath both your malleoli (the ankle bones on each side of your foot),” says Jordan. Elevate your toes a few inches by placing it on a cushion or mat. With the knee bent, gently glide shin forward. Shift back to start, then glide forward again. (P.S. Jordan has a how-to video for this exercise on his website.)
  • By Lauren Mazzo @lauren_mazzo

Why Weak Feet and Ankles Can Ruin Your Strength and Speed (And How to Fix Them)

Read More >>

Let’s face it: You never train your feet or ankles. That’s not necessarily your fault, since the vast majority of training programs don’t include foot or ankle exercises—except maybe some Calf Raises.

Perhaps a few of you do your warm-up or a few exercises like Deadlifts barefoot. That’s great, but it’s nowhere near enough, according to Dr. Joel Seedman, strength coach and owner of Advanced Human Performance.

In Seedman’s Foot and Ankle Manual (yes, the man has devoted an entire manual to these too-often overlooked body parts), he drives home the importance of feet and ankles for everyone from athletes to bodybuilders. Seedman explains that your feet and ankles are your base of support, and they dictate how your entire body moves. A foot or ankle issue can even result in weak upper-body muscles or neck pain.

RELATED: Why Athletes Should Warm Up Without Shoes

Seedman uses the Squat to illustrate the problems weak feet and ankles can cause.

“Squatting with weak feet and ankles contributes to faulty hip and knee mechanics, which indirectly affects the position of the spine,” he states. “Consequently, this poor spinal alignment is often associated with low-back pain, neck impingement, shoulder injuries and inhibition/weakness of the upper extremities, which together impede hypertrophy (muscle growth), strength gains and good health.”

Put simply, weak feet and ankles throw you out of the proper position on a lift or movement, making it next to impossible to use correct form and the right muscles. This all but guarantees you won’t get the full strength, power or size benefits from an exercise. And you’ll be at an increased risk of injury.

In sports like football and basketball, strong ankles and feet are essential to handle the extreme forces from sprinting, jumping, landing and changing directions. Otherwise, your risk of spraining an ankle skyrockets, as does the pain you’ll feel in your knees and other joints.

And there’s more bad news: With weak feet or ankles, you won’t be able to transfer the power from your hips and legs into the ground. That means you’ll be less explosive, slower when you sprint, and less able to jump high.

That’s why Seedman believes foot and ankle strength should be one of the first things taught to an athlete, even before they learn a basic movement like the Squat. The first step, he says, is to do some simple tests to get a baseline.

Testing Your Feet and Ankles

A simple test can tell you if your feet and ankles are weak or aren’t working properly. Stand barefoot with your feet hip-width apart and have a friend take a picture of the back of your ankles. Then compare it to this picture:

If your ankles are aligned vertically, they’re in decent shape. If your foot rolls inward (pronation) or outward (supination), you have a problem.

Correcting Your Feet and Ankles

Seedman’s Foot and Ankle Training Manual provides 13 foot and ankle workouts that he has personally developed with athletes who train at his facility.

In just one workout, he was able to make a major improvement in a client’s feet and ankles, which you can see in the image below.

The workouts take 10 to 15 minutes to complete and can be performed before a traditional strength workout. Seedman also includes a variety of plans for folks who want to take on a full foot and ankle training program to address major issues, or who need a simple and time-efficient maintenance plan.

I’ve been lucky enough to try several of Seedman’s workouts and have seen immediate results. After a few weeks, a lingering pain that I had in my upper foot/ankle disappeared. I now feel more confident when I do heavy Squats and Deadlifts, because my feet are properly gripping the ground.

In addition to adding foot and ankle training to your workouts, there are three things that everyone should do to keep their lower limbs and feet healthy.

RELATED: Lifting Socks Are a Thing and They’re Way Better Than Shoes

Activate Your Feet During Lifts

“Rather than having the feet sit on the floor like two limp pancakes, the goal should be to incorporate active foot mechanics ,” Seedman says. “Grip the floor aggressively with the feet, having more stress toward the outside of the foot. Activate your toes, especially the big toe. Imagine that the foot is screwing into the floor rather than passively resting on it.”

Wear Minimalist Shoes

You should be barefoot or wear minimalist shoes for least 50 percent of your training, practice and skill work, Seedman says. Minimalist shoes offer enough support to protect your feet and provide traction, but not so much support that they screw up your body’s biomechanics.

There are four attributes that make a shoe “minimalist”:

  1. A wide toe box that allows you to spread your toes.

  2. Flexibility that allows your feet to bend.

  3. Zero drop from heel to toe, so your foot is flat.

  4. Minimal cushion and ankle support.

Learn Proper Foot Mechanics

You need to learn to stand with your feet and ankles in the proper position. This may seem simple, but Seedman says that it’s “frustrating and uncomfortable” for many people. Here’s how to do it:

Step 1: Stand with your feet hip-width apart, pointing straight ahead.

Step 2: Push your feet outward without lifting them off the floor. They’ll move into a slightly supinated position. (If you are naturally supinated, you don’t need to do this.) With your weight now shifted to the outsides of your feet, press your big toes into the floor.

Step 3: Spread your toes apart as far as you can. Adjust your toes with your hands if needed.

Hold this position for 30-60 seconds. At first, it may become extremely challenging after 20-30 seconds.

RELATED: 27 Foot and Ankle Facts Every Athlete and Coach Should Know

Photo Credit: Getty Images // Thinkstock

5 Ways to Strengthen Weak Ankles

“Have an injury checked out if it’s limiting you from doing what you want to do.” If you feel pain in one of the bones, for example, you could have a stress fracture, says Geier. Continuing to train could make the injury worse.

Tendonitis and arthritis are two common sources of ankle pain that you may be able to manage through diligent stretching and strengthening. To address these concerns—and to help prevent ankle trouble in the first place—these 5 simple, effective exercises will keep your ankles happy.

More From Prevention: The No Squats Belly, Butt, And Thighs Workout

1. Peroneal Stretching/Strengthening

The peroneal tendons run along the outside of the ankle, and they’re crucial for strength and support, says Page. For athletes—particularly runners, dancers, and those who play ball sports, she recommend spending a minute to warm up these tendons.

The move is simple: Gently roll onto the outside of your feet and walk around for 60 seconds. This helps with flexibility and strength, Page says. “This also improves proprioception—awareness of where your ankle is and what it’s doing—which can help prevent ankle sprains.”

More From Prevention: 6 Moves That Target Stubborn Cellulite

2. Ankle Circles

This move will strengthen the muscles in and around your ankle, improving the joint’s stability. Sit on a chair and extend your right leg, knee straight. Move your right foot clockwise 10 to 20 times, rest your leg for 5 seconds, and raise it again and move your foot counterclockwise the same number of reps. Alternate legs, doing 3 to 4 sets per side.

You can add some variety to this move, says Paula Xavier, a trainer with NYC’s Naturally Intense studio and three-time Best of Manhattan Awards winner for personal training. Try moving your foot up and down (as if pressing a gas pedal), or from side to side (like windshield wipers). These moves will help improve your range of motion. Again, 10 to 20 reps for 3 to 4 sets.

More: 12 Ways to Build Ankle Strength for Top Performance

AFX Ankle Foot Maximizer: A Tool to Strengthen Weak Feet and Ankles

For most athletes, strong feet and ankles are absolutely vital to their performance and yet, shockingly, it is often the weakest area of the body! We spend the vast majority of our time walking / running / playing on flat surfaces wearing flat, well-supported shoes that don’t allow us to adequately strengthen our feet and ankles. Most people are reasonably strong in plantarflexion (pushing the toes away from you with a rigid foot, like pressing the gas pedal in a car), but are disproportionally weak in inversion (rotating the foot inwards), eversion (rotating the foot outwards), dorsiflexion / toe extension (pulling the foot and toes toward the shin), and toe flexion (curling the toes toward the underside of the foot).AFX enables athletes to strengthen the entire foot and ankle in a balanced fashion through a full range of motion, against resistance that can be easily increased or decreased, and allows you to focus your strengthening on two key areas. First, it enables you to mimic the functional movements you use on the field of play, so you can become stronger and more proficient at those movements. Second, and equally important, it enables you to strengthen those muscle groups that you don’t use to any great extent on the field of play, thereby avoiding problems that can arise from muscle imbalances and weaknesses. For example, a tennis player can perform toe flexion, inversion and eversion using high-speed movements and eccentric loading to improve their agility, quickness and explosiveness on the court. They then can easily strengthen their dorsiflexors and stretch their calf muscle through a full range of motion to reduce the risk of developing shin splints and Achilles issues.In 2008, an independent athletic performance study was completed using AFX that involved the Men’s Varsity Basketball Teams at Simon Fraser University and the University of British Columbia. Over a 12-week period during their regular season, when athletic performance typically decreases, those players who used AFX had a significant increase in their dynamic balance and lateral stability, their agility improved, and their one-step vertical jump increased by an average of over 3 inches, compared to those players who didn’t use the AFX.AFX is used by all types of athletes from all areas of sport and performance. It is used by gold medal winning Olympians, professional athletes, marathoners, dancers, weekend warriors, and the list goes on. If you use your feet to play a sport, strengthening using AFX can help.

Do you need to be a health care practitioner to use the AFX?

You definitely do not need to be a practitioner to use AFX (although if you have an injury we recommend you consult with a qualified healthcare professional!). In addition to the AFX being easy to use, we have made sure that all of our free instructional videos and programs are easy for everyone to follow. Each AFX comes fully assembled with a DVD that takes you through a strengthening program rep by rep, and even counts down how long you should hold each stretch. You can strap-in, and be strengthening in a matter of minutes. Also, it doesn’t take long to feel the results, just 8-10 minutes a foot, 3 times a week and you are well on your way.

He’ll begin with some conservative care methods, which usually involves rest, over-the-counter pain relievers and targeted physical therapy. A number of patients respond well to physical therapy sessions and notice an improvement in their ankles in a couple of weeks. However, if your ligament damage is more severe, the best option may be a minimally invasive operation. Dr. Silverman will make a small incision and artificially strengthen the ligaments so that they are tight and stable. Learn more about the procedure in this short one-minute video he produced explaining the operation.

For more information about treating weak ankles, reach out to Dr. Silverman in the contact box below.

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  • Bio
  • Latest Posts

Lance Silverman, MD

Dr. Lance Silverman is a board certified orthopaedic surgeon, with specialty training in the management of conditions of the ankle and foot. Treating Minnesotans with Ankle & Foot problems since 2004.

Latest posts by Lance Silverman, MD (see all)

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A:

Funny you should ask that question right now because one of my coaches, who is also a physical therapist, recently wrote an article on that very subject. I’ll let CTS Senior Coach Phil Astrachan give you the latest information:

Steady As She Goes: Strengthen your ankles and build a solid foundation
By Phil Astrachan, CTS Senior Coach

We all know the dreaded feeling of taking a step on unstable ground and feeling an ankle buckle. We can be four weeks or four months into a marathon training plan, playing catch with our kids, or walking out the front door when it happens. And when it does, it painfully halts any grand ideas we had about taking another step.

Of the injuries faced by walkers, hikers, and runners, ankle tweaks and sprains account for a fat majority. But here’s the good news: It’s easy to diagnose whether you’re at risk of this critical joint failingand it only takes a couple of basic exercises performed a few times a week to shore up the ligaments and muscles that support this crucial structure.

Loose Ligaments Sink the Fit
Three of the most common reasons for ankle sprains and pains are the following:

Abnormally Loose Ankles
Ligaments are the connective tissue that attaches one bone to another, and they help to support and stabilize our joints. Each of us are genetically predisposed to have a certain amount of tightness (or lack there of) in our ligaments. If you have a history of twisting your ankle from childhood to today, it could be an indication that you lack a sufficient support structure of ligaments around the joint.

One Sprain Leads to More Sprains
In addition to being born with loose ankles, you can also develop them due to a past ankle injury that never healed properly. When this happens, the ankle loses some of its original stability or soundness. The next time you land on it wrong and twist it, the joint snaps much easier than the first time it was injured. Compounding the problem is the healing process: When swelling occurs in a joint, the neural network that controls your muscles has a harder time doing its job. People often re-injure their ankle while tripping over something seemingly mundane, like stepping off a curb.

Poor Coordination A good number of ankle injuries occur to people with the bumbling coordination of Inspector Clouseau. This clumsiness is due to, of all things, lack of practice. All your joints are wired with receptors that help sense your ankle’s position and rally the muscles that control the joint to hold it in place. If you don’t use this wiring system on a regular basis through, say, a regular game of hoops or soccer that involves plenty of cuts, stops, and quick changes in direction, the systems grows weak and unstable.

Create a Firm and Lasting Foundation Fortunately, by fine-tuning your senses so they fire more rapidly and by strengthening the muscles that surround the ankle, you can reduce the chances of future or recurring ankle injuries. The following exercises are designed for this purpose and should only be performed if all movements are pain free. Try doing them two times per week to keep your ankles strong. Recovering from an ankle injury, or think you have loose ankles? Do them three times a week.

1. Single leg balance: Without any support, stand on one leg for 30 seconds. Repeat six times with each leg. Begin with your eyes open, then progress to standing with your eyes closed. Once your master that, move on to standing on a slightly bent knee.

2. Toe-Heel: Sit in a high chair so that your foot comfortably hangs approximately two inches off the ground (use a stack of books on a chair to get the height set). Rhythmically tap your toe and then heel on the ground, trying to isolate all movement in the ankle. Start slow and build up speed to produce a fast but rhythmical tapping. Do 3 sets of 50 reps.

3. Side-to-Side: In the same sitting position and rhythm as Toe-Heel above, touch the outside edge of your foot on the ground and then your foot’s inside edge for one rep. Again, start slow and isolate the moment in the ankle as best your can. Speed up the rhythm as your coordination improves. Do three sets of 50 reps.

4. Wobble Board: Sit in a chair and place one foot in the center of a wobble board or Bosu platform with 360 degrees of rotation. Rotate the foot in a circle so the edge of the wobble board comes close to the floor but doesn’t touch. As your balance and coordination improves try standing on the wobble board with one leg. Do two sets of ten of the following motions for each foot: a. Forward-Backward, b. Side-to-Side c. clock-wise and counter-clockwise.

Filed To: Agility and Balance Lead Photo: Maridav viaGetty Images

Ankles provide a rare opportunity to recreate a seminal medical study in the comfort of your own home. Back in the mid-1960s, a physician, wondering why, after one ankle sprain, his patients so often suffered another, asked the affected patients to stand on their injured leg (after it was no longer sore). Almost invariably, they wobbled badly, flailing out with their arms and having to put their foot down much sooner than people who’d never sprained an ankle. With this simple experiment, the doctor made a critical, if in retrospect, seemingly self-evident discovery. People with bad ankles have bad balance.

Remarkably, that conclusion, published more than 40 years ago, is only now making its way into the treatment of chronically unstable ankles. “I’m not really sure why it’s taken so long,” says Patrick McKeon, an assistant professor in the Division of Athletic Training at the University of Kentucky. “Maybe because ankles don’t get much respect or research money. They’re the neglected stepchild of body parts.”

At the same time, in sports they’re the most commonly injured body part — each year approximately eight million people sprain an ankle. Millions of those will then go on to sprain that same ankle, or their other ankle, in the future. “The recurrence rate for ankle sprains is at least 30 percent,” McKeon says, “and depending on what numbers you use, it may be high as 80 percent.”

A growing body of research suggests that many of those second (and often third and fourth) sprains could be avoided with an easy course of treatment. Stand on one leg. Try not to wobble. Hold for a minute. Repeat.

Video

Ankles: A Balancing Act

Ankles sprains are the most common injury for physically active people. Professor Jay Hertel of the University of Virginia demonstrates four balancing exercises to strengthen ankles.

By Clare Major on Publish Date July 8, 2009.

This is the essence of balance training, a supremely low-tech but increasingly well-documented approach to dealing with unstable ankles. A number of studies published since last year have shown that the treatment, simple as it is, can be quite beneficial.

In one of the best-controlled studies to date, 31 young adults with a history of multiple ankle sprains completed four weeks of supervised balance training. So did a control group with healthy ankles. The injured started out much shakier than the controls during the exercises. But by the end of the month, those with wobbly ankles had improved dramatically on all measures of balance. They also reported, subjectively, that their ankles felt much less likely to give way at any moment. The control group had improved their balance, too, but only slightly. Similarly, a major review published last year found that six weeks of balance training, begun soon after a first ankle sprain, substantially reduced the risk of a recurrence. The training also lessened, at least somewhat, the chances of suffering a first sprain at all.

Why should balance training prevent ankle sprains? The reasons are both obvious and quite subtle. Until recently, clinicians thought that ankle sprains were primarily a matter of overstretched, traumatized ligaments. Tape or brace the joint, relieve pressure on the sore tissue, and a person should heal fully, they thought. But that approach ignored the role of the central nervous system, which is intimately tied in to every joint. “There are neural receptors in ligaments,” says Jay Hertel, an associate professor of kinesiology at the University of Virginia and an expert on the ankle. When you damage the ligament, “you damage the neuro-receptors as well. Your brain no longer receives reliable signals” from the ankle about how your ankle and foot are positioned in relation to the ground. Your proprioception — your sense of your body’s position in space — is impaired. You’re less stable and more prone to falling over and re-injuring yourself.

For some people, that wobbliness, virtually inevitable for at least a month after an initial ankle sprain, eventually dissipates; for others it’s abiding, perhaps even permanent. Researchers don’t yet know why some people don’t recover. But they do believe that balance training can return the joint and its neuro-receptor function almost to normal.

Best of all, if you don’t mind your spouse sniggering, you can implement state-of-the-art balance training at home. “We have lots of equipment here in our lab” for patients to test, stress, and improve their balance, Hertel says. “But all you really need is some space, a table or wall nearby to steady yourself if needed, and a pillow.” (If you’ve recently sprained your ankle, wait until you comfortably can bear weight on the joint before starting balance training.) Begin by testing the limits of your equilibrium. If you can stand sturdily on one leg for a minute, cross your arms over your chest. If even that’s undemanding, close your eyes. Hop. Or attempt all of these exercises on the pillow, so that the surface beneath you is unstable. “One of the take-home exercises we give people is to stand on one leg while brushing your teeth, and to close your eyes if it’s too easy,” Hertel says. “It may sound ridiculous, but if you do that for two or three minutes a day, you’re working your balance really well.”

Foot Issues Related to Tight Calves

Tight calves are one of the most common soft tissue issues I see. As a population, the majority of our movement is forward-based, so the muscles on the backside of our bodies get tight; this includes both the hamstrings and calf-achilles complex.

Most people, including athletes, should stretch these posterior-chain muscles on a regular basis, but neglect to do so.

When your calf-achilles complex is tight, it will pull at its attachment point on the back of your heel. This will pull the heel up and off the ground earlier than normal.

Your body weight will shift forwards and you can overload the forefoot, knees, hips and low back. While tight calves are not the root cause of most issues, they can exacerbate pain due to increased loading.

Some of the common issues correlated to tight calves are:

Forefoot Pain

An early heel lift will mean you spend more time on your forefoot. If you have a collapsed metatarsal, or forefoot, arch, this can aggravate pressure on the toe joints and reduce the space for nerves to run in-between the toes. This interdigital nerve entrapment can lead to numbness, tingling or neuromas.

Posterior Heel/Achilles Pain

Chronic tension on the back of the heel from calf-Achilles tightness can lead to localized inflammation. Some people can develop a bony prominence on the back of the heel called a Haglund’s bump. This can make shoe fitting a bit more challenging than otherwise. Bone spurs can also develop as a result of that chronic tension. Lastly, the Achilles’ tendon itself can become inflamed and turn into a full-blown Achilles’ tendinopathy.

Ankle Discomfort

Because tight calves cause an early heel lift, you will spend more time on the forefoot with the heel and ankle elevated. This elevated position means that the musculature spanning the ankle joint has to do a lot more work to keep the ankle stable. Some patients will complain of pain or discomfort that runs down either side of the ankle bone.

Knee Discomfort

As your body weight shifts forwards from an early heel lift, you load the anterior – or frontal – compartment of the knee more than is typical. Anyone with a history of knee injury or osteoarthritis in the joint should make sure to stretch their calves so as to limit the aforementioned increase in load.

READ MORE: Treatment Options for Common Knee Injuries

Stretches

Below are some calf stretches you can add into your daily, or post-workout, routine. Make sure you hold each stretch for 45-60 seconds to get the full benefit of the stretch!

You can also use a foam roller or a stick roller to roll out the calves. This has the added effect of ensuring the muscles don’t adhere to one another and can allow a physiotherapist or massage therapist to get deeper through the tissue.

Standing Calf Stretches – Gastrocnemius and Soleus

Gastrocnemius Stretch

(image a)
Stand about three feet from a wall and step your right foot behind with your toes are facing forward. Keep your heel on the ground and lean forward with your right knee straight. Hold this for 30 to 60 seconds, then switch to the other side.

Soleus Stretch

(image b)
Stand away from a wall and step your right foot behind with your toes are facing forward. Lean forward at the ankle while bending the right knee and keeping your heel on the ground. Hold this for 30 to 60 seconds, then switch to the other side.

READ MORE: 4 Injury-Reducing Stretches for Runners

Heel Raises

Stand with your toes and the balls of your feet on a step with your weight forward. Hold onto a support for balance if needed. Lift your heels as high as you can. Then, slowly lower your heels below the step line until you feel a good stretch in your lower calves. Hold for 45 seconds to a minute.

Talk To An Expert!

If you have any questions or concerns about tight calves or other conditions, talk to a pedorthist at a Kintec location near you!

Kristin Ohm-Pedersen, B.HKin, C. Ped (C)
Kintec Pedorthist

The left photo of a client’s attempt at active dorsiflexion (meaning, as far as she can pull her foot back toward her head without using external support to get it to go farther). In the right photo is my foot demonstrating my active dorsiflexion.

I placed the dotted line from the center of the heel up through the edge of the ball of the foot to show the difference in angles of our foot to our calves. There is no magical amount of ankle mobility that everyone should have. There is only – do you have enough mobility to do the things you want to do?

When you don’t have enough mobility in your ankles to walk, run, go up or down stairs, do activities, or play sports – you might start experiencing aches or pains. Or you may find that you just can’t do the movement or activity you were intending to do. Tight calves, and foot and ankle issues can range from feeling uncomfortable to downright painful, and what is true for every area of your body is also true for your ankles:

Where one area is lacking, somewhere else will always try to make up for it.

Let’s discuss how to make your ankle move better so that you can start changing how your calves and feet feel.

If you were just a bony skeleton, aside from being slightly creepy yet totally badass skeleton person, your ankle would move in all the ways it is an ankle joint is built to.

But you’ve got soft tissue – skin, connective tissue, muscles, tendons, and ligaments – and – you have the king that rules over all of that soft tissue.

To change your ankle mobility and help your calves feel better, you must address both the soft tissues and the king that rules over them.

Why Does Tightness In The Calves Happen?

This is important to know about because you’re going to do the work to help your calves feel and function better, and you don’t want to short change yourself by being unaware of the things that cause them to get tight, painful, and immobile.

There are two main contributors to sub-optimal ankle mobility and tight calves:

  • Lack of regular movement through the full range of motion of the ankle (that is, you stop telling your ankles they should have complete range of motion, good mobility, and full control)
  • Shoes that act like casts on the foot and ankle (this includes all positive heeled shoes, some runnings shoes, and all flip flops)

In this post, I’ll cover the first contributing factor, and how to fix it. And if you need more guidance on shoes that are negatively impacting you, check out this FFRL article.

(There are rare instances when a bony block legitimately prevents you from accessing what would be considered “normal” ankle range of motion. This is indicated by having imaging done to view the bony tissues and see that something is actually impeding the joint from norma function. These are rare, which means you more than likely, can improve your ankle mobility.)

Tight Calves…So What?

Think of what your stiff, tight, calf muscles are connected to – the foot and ankle (& knee, but we’re focusing on the lowest of appendages today). They are two parts of the body that must have mobility to function correctly.

Here’s an example to showcase this. Follow along with me in the video as you try to make the biggest circle you can with your wrist. Don’t move or rotate your forearm at all!

A post shared by Kate Galliett (@kategalliett) on Nov 9, 2016 at 4:16pm PST

Was your circle big and smooth like mine? (If not, we’ve found another place to address your mobility! Let’s keep focused on your ankles and calves for today though.) The large circle motion of the wrist is similar to the large circle motion that the ankle is built to do.

Compensations And Dysfunction

When you lose ankle range of motion, all of the soft tissues around the ankle and lower leg will compensate for the lacking mobility.

The soft tissue on the front of the shin will have to work harder to dorsiflex the ankle so that you can walk, squat, and go up and down stairs. And the soft tissues around the sides and back of your calf can become stiff, tight, and weak…making it more difficult to resist ankle sprains, as well as making it more difficult to move with freedom.

In addition, the plantar fascia gets caught up in the dysfunctional movement of the lower leg and ankle. Normally, it acts like a tie rod, undergoing tension when you load the body. But if the muscles of the foot and lower leg do not support the dispersement of load across all of the tissues, the plantar fascia will take on more load with each step you take. This is one way plantar fasciitis can develop.

When your calves shorten as part of the loss of mobility, your body shifts its weight distribution forward over the mid-foot instead of over the heel as it was designed. Katy Bowman made a fantastic picture showcasing this shift:

When this goes on for long enough, the plantar fascia will harden and eventually calcify. What was once a supple piece of tissue becomes a rigid piece of tissue that is now being loaded with no real way to displace that load through the rest of the foot.

(This can also be a culprit behind stress fractures on the 2nd or 3rd ball joint and navicular bone of the foot. Improper loading of the foot and its tissues, puts more load on the bones in the front of the foot. Hard, bony, tissues are no different from soft tissues…they are impacted and will respond to the forces being placed on them.)

The King That Rules Your Mobility

Your nervous system oversees how much mobility you have access to. And while gaining passive range of motion is important (think: static stretching), the problem with only working on passive range of motion is that it does not allow the nervous system to learn valuable information about that position, such as, how to generate control, strength, and safety in that position.

In order for your nervous system to understand how to access new ranges of motion safely and with control, you must teach it. This is done by performing neural control training to teach the tissues you are working how to contract through the full range of tissue length, not just the mid-ranges of the tissue length, but the end-ranges as well.

Action Plan To Start Helping Your Calves

You did not create stiff, tight, calves and ankles overnight – and you will not restore them overnight. But every signal you send to your body to tell it how you want it to adapt will be responded to. With consistent effort, and intelligent signaling to your body, you can change the way your joints and tissues feel.

Here’s how to get started working on your tight calves and ankles:
– Perform stretches every day for your calves as a movement break in your day. By increasing the volume of the signal that says “move the ankle into dorsiflexion”, you will signal that you’d like to maintain your current range of motion, continue sending healthy blood supply to the tissues and joints, and improve the health of the tissue and joint. While static stretching alone is not the answer, it is a component that will assist the entire process along.

– Start using neural control training to get your nervous system involved in the process of developing usable mobility, not just passive flexibility. It is best if you learn neural control training from a teacher or coach. There is a lot of detail and nuance that goes into it that just cannot be conveyed completely through an instagram post or blog. You can learn from someone local to you, or to learn with me you’ll want to be a part of my coaching group.

– Get out of your positive-heeled shoes. Including your running shoes. But do not go cold turkey down to zero-drop shoes. Expect to spend many months training your feet to go from typical positive-heeled shoes down to flat zero-drop shoes.

– Walk around barefoot every single day. You were born capable of doing this. Do not die incapable of it. Start easy, on soft surfaces for a few minutes per day if it hurts. Work up to walking on a variety of surfaces barefoot. Grass. Rocks. Concrete. All of it.

– Remind yourself that this will take time, so a little patience will go a long way. 🙂

Get a complete foot training program

If you’re serious about healing your feet, getting rid of the pain, and building strong, durable, feetthen you’ll want a complete foot training program. I’ve helped hundreds of people heal their feet with the drills and exercises I’ve put together into my new easy-to-follow program, Unbreakable Feet.

Last year, Colleen Callahan was training hard for her first 10K when she began to notice a nagging pain at the base of one of her toes when she ran. The diagnosis? A sprained big toe. The injury surprised her; she didn’t recall experiencing any trauma. But what was really surprising was the cause of the injury: ankle immobility.

“Her Achilles’ tendon was so tight she couldn’t get a proper range of motion in her ankle. She was compensating by pushing off harder with her toe when she ran,” says her sports chiropractor, Darren Hancock, DC, of Chicago Chiropractic and Sports Medicine.

Immobile ankles can wreak havoc all along your kinetic chain. You’ll usually experience some form of knee pain, though it’s not uncommon for the dysfunction to travel as high as the back or shoulders — or as low as a toe.

After a bit of rest, Callahan, 22, began incorporating ankle mobilization exercises into her routine, which allowed her to not only complete her 10K, but also to start training for a marathon. The trick, however, is to improve ankle mobility before it causes trouble — and thereby prevent a lot of needless pain down the road.

The Dorsiflexion Dilemma

Good ankle mobility does not involve being able to roll the ankle laterally. Rather, it means being able to properly dorsiflex your foot (pull it upward) and also plantarflex it (point it downward). “Normal is 20 degrees for dorsiflexion and 50 degrees for plantarflexion. Anything less is considered limited,” says physical therapist Bill Hartman, PT, CSCS, of Indianapolis Fitness and Sports Training.

To approximate what 20 degrees dorsiflexion looks like, place the toes of one foot 2 to 3 inches from a wall, then, keeping your heel on the floor, move your knee forward until it touches the wall. If you can touch the wall without lifting your heel, you’ve achieved 20 degrees.

To eyeball ideal plantarflexion, sit with your legs extended, toes pointing straight up. That’s zero degrees. Now point your toes away from your body; if you can reach an angle just past halfway to the floor, that’s 50 degrees.

Most of us are sorely lacking in the dorsiflexion department. One reason? The calf muscles that control plantarflexion (the gastrocnemius and soleus) tend to be stronger than the muscles that control dorsiflexion (the tibialis anterior), according to Jimmy Smith, MS, CSCS, a strength trainer in Stamford, Conn.

Dorsiflexion detractor No. 2 is immobile plantar fascia in our feet and ankles. Repetitive activity (such as running, jumping or prolonged walking) can cause this band of connective tissue that runs along the bottom of the foot from the heel bone to the base of the toes to shorten and constrict the muscles around the ankle, impeding movement in the ankle itself.

The third factor — tight calves — is probably the most ubiquitous, says Hartman. “It’s a flexibility issue common in 99 percent of the population,” he notes. “Because we sit for long periods of time, walk on nothing but flat surfaces and make poor choices about shoes, we’ve demanded less and less from our bodies,” which essentially causes our body parts to forget what they’re supposed to be doing.

“High heels cause you to lose range of motion because your calf muscles are placed in a shortened position for an extended period of time,” explains Hartman. And high-tops force the knee into a weak, unnatural position as it compensates for the ankle’s lack of mobility.

Monitoring Your Mobility

So how do you know if you have immobile ankles? Knee pain is usually the first sign. Though, as Hartman notes, it can manifest elsewhere. Other indicators include lack of squat depth, premature lifting of the heel while walking or excessive pronation of the foot — all things a physician or physical therapist can help you determine. (See “Screen Test” below.) It’s also possible you have soft-tissue restrictions that need to be worked out by a soft-tissue expert.

Whatever the symptoms, there’s plenty you can do on your own to improve ankle mobility. Consider the suggestions presented below as a step in the right direction.

Screen Test

There’s no substitute for a professional evaluation, but if you want to assess your own ankle mobility, try these self-tests:

Ankle Angle Screen

Bill Hartman, PT, CSCS, suggests using this assessment for ankle mobility:

Stand barefoot, toes pointed forward, facing a wall. Place one foot about 2 inches from the wall, and without lifting your heel, bend your knee until it touches the wall. If you can do this, move back an inch and try again. If you can still touch, you’re doing OK. “Ideal distance is based on limb length, but being able to complete the knee touch with your toes between 2 and 3 inches from the wall demonstrates you’ve got a normal range of dorsiflexion,” says Hartman. (Try with both legs: They should be symmetrical.)

Overhead Squat Press

Have a friend take a few pictures of you doing an overhead squat. Stand with your feet shoulder-width apart. Hold a broomstick or something comparable horizontally over your head. Keep your chest up, back straight, and look ahead.

You should be able to get your thighs perpendicular to the floor. If your arms fall forward past the line of your trunk, then add a heel lift. If the heel lift solves the problem, the issue is primarily in the ankle, says Gray Cook, OCS, CSCS, a physical therapist in Danville, Va.

Work It Out

Two common causes of immobile ankles are tight calves and immobile plantar fascia along the bottoms of your feet. If either of these problems is restricting your ankles, doing a few minutes of stretching and soft-tissue work every day will improve your ankle mobility, says Bill Hartman, PT, CSCS. If you don’t see improvement in six weeks, seek professional attention.

Massage Your Calves

Stand with left foot forward, knee slightly bent (you may find it easiest to drop down onto your right knee). Using a tennis ball, gently apply pressure just below your gastroc and soleus (large calf muscles) of the left leg. Using a short rocking motion, apply massaging pressure with the tennis ball while you dorsiflex your foot (without lifting your heel, lean knee forward as described in “Ankle Angle Screen” above). Spend a couple of minutes working upward onto your gastroc and soleus. Then repeat on right leg. This exercise will loosen up your calf muscles and thus help increase dorsiflexion, says Hartman.

Stair Stretch

Stand on a step on the balls of your feet and let your heels lower toward the floor. Hold for 30 seconds. Do this with knees straight and then with knees bent, three times per position. You should feel a big stretch in your calves, not a pinch or “stuck” feeling in the front. If the latter occurs, see a physician to rule out a problem in the joint itself.

Play Foot-Ball

Use a golf ball or tennis ball to massage the bottoms of your feet. Work on one square inch at a time. Place firm pressure on the ball with your foot, but do not stand on the ball. Do this for two to three minutes for each foot to reduce tension in the fascia and allow greater dorsiflexion.

WEB EXTRA!

Control Mobility

You don’t want to develop mobility without muscle control — otherwise you could be putting yourself at risk for joint instability. These exercises will improve your sensorimotor control and stability. Lower intensity and more frequency is ideal to build endurance in these stabilizing muscles, says Mike Davis, a physical therapist in northern Virginia. Single Leg Ball Throws Stand on one foot. Bring your other leg forward and bend it 90 degrees from the knee, thigh parallel to floor. Dorsiflex your foot — pull your toes toward your shin — and have a partner toss you a light medicine ball. Imagine that your torso is broken up into four quadrants (upper right, upper left, lower right, lower left). Have your partner throw to each of those quadrants three times. Switch legs and repeat. Ankle Alphabet Trace the entire alphabet in the air using only your foot and ankle. (In other words, don’t move your knee or hip.) Do this a few times a day with each foot to improve controlled mobility.

Jenny Liu Jenny Lui is a Chicago-based writer.

Ankle pain after squats

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