Dorsiflexion: Definition/Issues
What Is Dorsiflexion?
In all reality, it’s probably one of the most common movements that occur in the human body. Ankle dorsiflexion is the movement that occurs when your foot and shin approximate closer together (note: dorsiflexion can also occur elsewhere in the foot, such as toe dorsiflexion, as well as in the hand where unhealthy wrist dorsiflexion can affect patients with carpal tunnel syndrome, however we are typically referring to foot dorsiflexion when we discuss dorsiflexion).
It is arguably one of, if not the most important lower body movement from a functional standpoint. It occurs during all sorts of movements such as walking, running, squatting, and lunging.
We’re going to break down foot dorsiflexion - from how it occurs in the foot and ankle joint, to what problems can occur when you don’t have it, as well as certain ways that you can improve your range of motion in this regard.
An Anatomical Perspective
Let’s start by taking a closer look at the anatomy to understand how foot dorsiflexion takes place. The ankle joint - known as the talocrural joint, is a hinge joint that is formed from the ends of the tibia, fibula, and the talus. The ankle joint is held together by several fibrous ligaments that help the joint maintain its stability. A joint capsule is connective tissue filled with fluid that serves as a type of natural ‘hinge’ in the body.
The two main motions at the ankle joint are plantar flexion (toes pointing downward involving the plantar fascia) and dorsiflexion (toes pointing upward). Other motions occur in the ankle as well, such as inversion and eversion, however they occur at other joints in the ankle.
Normal Dorsiflexion
While normal range of motion for a dorsiflexed ankle ranges between 10-20 degrees1, there are certain factors that can cause this plane of motion to be restricted.
Common Issues
Tight Calves
Perhaps the most common way that foot dorsiflexion becomes restricted is due to soft tissue. For example, your calf muscle (gastrocnemius) as well as a muscle slightly deeper, (known as the soleus), can play a huge factor in determining how much range of motion you have at the ankle joint. These muscles are direct antagonists to dorsiflexion. If you experience muscle tightness in these “dorsiflexion muscles”, you will lack the proper amount of plantar flexion and dorsiflexion.
Trigger Points
Trigger points, or “knots” can also occur in these muscles which can also cause restriction. Trigger points are hypersensitive nodule located in taut bands of skeletal muscle. While the science behind why trigger points occur isn’t exactly clear, trigger points cause certain areas of the muscle belly to become excited, thus creating more tension in the muscle.
Weak Muscles
Another common thing that we find in people who have reduced dorsiflexion is weakness in the agonist muscles, or, the muscles that dorsiflex the ankle. Patients often can display weakness in muscles of the anterior compartment of the leg. Common muscles involved are usually tibialis anterior, extensor hallicus longus, and extensor digitorum longus.
Certain Specific Ailments
Additionally, other things that can cause restrictions of your ankle joint are things such as arthrofibrosis, arthritis, and scar tissue (2). Many of these things are visible in imaging.
In our office, we often find that the things that limit dorsiflexion usually are not due to one of these things, but rather a combination of them.
Why is this all important?
As we previously mentioned dorsiflexion plays a huge role in some of the most fundamental movements that you do in your everyday life. Whenever you lack movement in one area, chances are that your body will try to make up for it in another.
What happens when you start asking other joints to do things that they aren’t typically responsible for? You start to put extra stress on the joint. What happens when you start to put extra stress on the joint? Your brain starts to learn poor movement patterns. What happens as a result of poor movement patterns? Pain.
Flexion in the Squat
For example, let’s take a look at the squat. Many people think about the squat from the standpoint of exercise involving extra weight or just body weight, but what you often don’t realize is how often your body is actually squatting on a daily basis. Squatting occurs whenever you sit in a chair, or when you go to the bathroom. Realistically, you squat a lot more than you think.
What Movements are Involved in The Squat?
Globally, the squat involves three major joints- the hip, the knees, and the ankles. During the downward phase of the squat, your body does three things- hip flexion, knee flexion, and ankle dorsiflexion. If you lack ankle dorsiflexion, you can bet that your knees will flex a little more to make up for this lack of movement. When they do so, it can create more stress on the anterior aspect of the knee, namely the ACL.
What is even more interesting is that there are studies that have found that lack of dorsiflexion can contribute to specific kinematics most often seen in ACL tears (3). While it has not been found to be a direct risk factor, there is definitely evidence out there that weak dorsiflexion can indirectly be associated with this particular type of trauma.
It has also been found in studies that maintaining proper dorsiflexion of the ankle during upper leg strengthening exercises such as a leg extension can strengthen the muscles that aid dorsiflexion while also keeping the knee healthy.
Walking/Running
As previously mentioned, dorsiflexion also plays a huge role in walking and running. During the stance phase of your gait, your weight shifts from your hindfoot, to your midfoot, and then to your forefoot. During this shift in weight, you can actively see dorsiflexion occur.
Having adequate dorsiflexion is extremely important because it stores energy for an effective “toe-off”, which essentially is responsible for propulsion of your body forward. This movement becomes particularly important in explosive athletes such as sprinters, football players, basketball players, and many others. Adequate dorsiflexion decreases the ground contact time, which as a result can increase your speed4. The lighter you are on your feet, the faster you are!
Presentation
We find restriction in this plane of motion on people in our office daily. It can be obvious, with patients presenting with ankle pain. Sometimes, the patient doesn’t even present with any symptoms in the ankle. They may have foot pain, knee pain, hip pain, or even low back pain. Other times, they may have reoccurring ankle sprains due to faulty biomechanics because they lack dorsiflexion.
There are certain exercises that can help. The Gray’s Anatomy Academy recommends adding a sled push to your training regimen as a way to strengthen the muscles that aid dorsiflexion and improve flexibility5.
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Whatever the case may be, as practitioners we are mindful of the importance of this movement. If we find restriction in this area, we address it using a variety of techniques. Usually the problem is due to muscular imbalance-in which case we want to address tight muscles with stretching, and weak muscles with strengthening exercise.
We also look at any myofascial issues that you may be having, such as trigger points as mentioned above. Certain myofascial issues are usually best addressed with manual therapy. In our office, we use trigger point therapy, myofascial release, instrument-assisted soft tissue mobilizations, and various modalities to resolve this issue. If necessary, we address any further restrictions with manipulation of the joint.
Dorsiflexion is a very important fundamental movement that we are constantly doing in our everyday life. Having adequate dorsiflexion can allow you to accomplish activities of daily living more effectively, as well as improve your overall performance in various activities. If you have any questions or would like to talk more about this particular movement, as always we would be happy to help out in anyway that we can!
Stay Moving!
References
1. https://www.merckmanuals.com/professional/special-subjects/rehabilitation/physical-therapy-pt
2. https://www.ncbi.nlm.nih.gov/pubmed/22851323
3. https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1076&context=exsci_fac
4. https://www.runnersworld.com/training/a20866310/flex-your-ankles-for-more-speed/
5. Gray’s Anatomy Academy Instagram Post with video - https://www.instagram.com/p/Cg4F9otu0Hq/