Stability of the Foot & Ankle

Foot and ankle stability starts at the pelvis, pelvis position influences the biomechanics down the chain of muscles, joints and bones of the lower extremities. Stability at the foot and ankle is the ‘ability of the foot to continually adjust its position to maintain the body in an upright balanced position,’ that will help you be able to sense foot position on the ground preventing injuries or falling. (reference) Muscles that are influenced by the pelvis can be in a lengthened and weak position or short and strong position which can create instability at the ankle, so to look at ankle stability we first have to address hip stability. (refer to hip stability post here)

Setting the pelvis in positions where it can alternate side to side and function symmetrically on both the left and right side will help position the femur and tib/fib and will influence the talocrural joint. This is the first step to increasing ankle stability, if the pelvis is not in proper position and you have done ankle work, as soon as you get upright against gravity the ankle will adjust to the position of the hips, if not you will fall over due to balance issues. Mechanical instability is likely the cause of functional instability of the ankle, so restoring the biomechanics is the first priority of the ankle. Looking at stability of the foot is looking at high and low arches, a more inverted ankle or more everted ankle. Now we can influence a raised arch sometimes but we cannot permanently change the low arch or collapse foot we have, however we can strengthen the tissues around the joint to be able to adjust for the load and force we place on it.

The ankle joint reaches a very stable position with maximal dorsiflexion. Ankle locks movement and becomes more unstable with plantar flexion. Its most vulnerable position is the plantar flexion with inversion which leads to lateral ankle sprains which comprises 83% of ankle injuries. Proprioception is a key component to ankle stability for neuromuscular control, one must sense the foot through the ground and get a sense of where they are in space. (Crucial) For improvement in sense, we need to increase the mechanoreceptors, and muscle activation of the ankle to create a better proprioceptive response. We can increase muscle activation by training the ankle invertors and evertors in a standing position to allow the body to recognize the forces, thus strengthening the muscles and tendons. Another way to increase strength and stiffness is through exercises on an unstable surface, this can also build neuromuscular control. Another way that has shown to be slightly better than balance training on an unstable surface is training with short foot exercises, elevating and supporting the medial longitudinal arch of the foot has shown to improve standing balance and create stability through the ankle and foot.

These exercises can be added into the warm up of your exercise program and built in daily. Pick an exercise and work on feeling and sensing the ground, the musculature of the ankle and feet working to support the load. Programming appropriate exercises that put the ankle through dorsiflexion and plantar flexion are also key to enhancing stability. This means grounding the foot into the floor without the hindrance of a machine and may require you to temporarily remove your shoes.

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