Latest / The Driven Athlete / Foot & Ankle Mechanics: Are You Pronated, Supinated, or Lacking ROM? | Ep 72

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Foot & Ankle Mechanics: Are You Pronated, Supinated, or Lacking ROM? | Ep 72 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: So the foot and ankle common thing we see active individuals with issues right, pain and dysfunction in the foot and ankle, and I've talked with a lot of experts on this and collaborated with people and it's an enjoyable thing to help people get better and I enjoy working on the ankle with people and the foot.
• 0:36
  Speaker 1: It's a cool joint region of joints that we can work on to improve their functionality and decrease pain.
• 0:44
  Speaker 1: A little bit of insights on the ankle, all right.
• 0:47
  Speaker 1: So the number one thing that we find with active individuals is just lacking pure ankle dorsiflexion, range of motion, all right.
• 0:56
  Speaker 1: Ankle dorsiflexion is when you bend your toes up towards the ceiling, right, if you're standing and you lift your toes up to the sky.
• 1:03
  Speaker 1: Bending your ankle backwards in that position is called dorsiflexion.
• 1:07
  Speaker 1: When somebody points their toes down like hitting a gas pedal, that direction is called plantarflexion, plantar being like the bottom of your foot, but ankle dorsiflexion is one of the most common.
• 1:17
  Speaker 1: A lack thereof of ankle dorsiflexion, pure range of motion is one of the most common things that we find in people that are battling ankle issues, knee issues, hip issues and relationship to back issues.
• 1:30
  Speaker 1: We just can't leave that neglected to look at, even with back pain, hip pain, knee pain, whatever for functional activity like squats and lunges and step ups and running and stuff, or even the normal gait pattern.
• 1:41
  Speaker 1: The reason is because upstream and downstream of the kinetic chain there are influences from the foot and ankle.
• 1:48
  Speaker 1: As it relates to your back, things will compensate naturally above, upstream in the kinetic chain and just overcompensate for because of impaired mechanics and lacking range of motion, lacking stability, whatever.
• 2:01
  Speaker 1: And that's where the puzzle piece comes in for us.
• 2:03
  Speaker 1: It's like what's really the problem that we need to work on?
• 2:05
  Speaker 1: And ankle dorsiflexion is a super common one.
• 2:08
  Speaker 1: All right, the talocrural joint is the talus sitting over top of the calcaneus.
• 2:14
  Speaker 1: Sorry, the talocrural joint is the talus bone sitting in the ankle mortis, which is the distal part of the tibia, the shin bone and the fibula, just lateral, and the talus sits in there and it moves backwards and forwards, it rolls forwards and backwards and if it doesn't roll backwards or shift posteriorly enough, then the ankle dorsiflexion range of motion is going to be a little bit impaired and limited.
• 2:37
  Speaker 1: So with that, if somebody does squats or lunges or step ups and running and walking, if the pure ankle dorsiflexion is limited, then the foot and ankle is going to move a different direction to make up for that, what we would call a compensation, and usually the ankle that we find will roll into eversion.
• 2:57
  Speaker 1: Eversion is when the foot rolls outwards.
• 3:00
  Speaker 1: Inversion is when the ankle rolls inwards.
• 3:04
  Speaker 1: So an inversion ankle sprain is one of the most common ankle sprain injuries for athletes.
• 3:09
  Speaker 1: Just like if they rolled their ankle, they're usually rolling their ankle into inversion.
• 3:12
  Speaker 1: Rolling into eversion is the opposite direction, where the inside of the ankle is getting stretched and the outside of the ankle is getting compressed or approximated All right, so people will roll.
• 3:24
  Speaker 1: Athletes, active people will roll into eversion to overcompensate for a lack of pure ankle dorsiflexion.
• 3:30
  Speaker 1: All right, so the ankles will kind of roll outwards and with that we have foot arch collapse.
• 3:36
  Speaker 1: So the arch of the foot is a necessary thing for foot stability.
• 3:42
  Speaker 1: Against what most people might think, we can improve functional arch stability.
• 3:49
  Speaker 1: Some people naturally have flat feet and some people have naturally huge arches, right.
• 3:54
  Speaker 1: Of course there's a ceiling with how much we can influence the arch capacity in either direction.
• 4:01
  Speaker 1: But we can definitely still work on functional arch stability with movement control, with movement activities let's just say Running, walking, squats and lunges and stuff like that.
• 4:11
  Speaker 1: If somebody's just slamming into eversion and their foot arch collapse, longitudinal foot arch collapse, that sets the stage for things to compensate again, right.
• 4:21
  Speaker 1: So we see people that come in very frequently that are demonstrating a lack of ankle dorsiflexion.
• 4:27
  Speaker 1: They roll into eversion.
• 4:29
  Speaker 1: When they bend their ankle backwards, like when they descend in a squat, their foot arch collapses and they also will like roll their feet outwards into external rotation.
• 4:40
  Speaker 1: Their toes will point out as they go down and then they'll stand back up again and the feet will roll in.
• 4:44
  Speaker 1: That external rotation is a classic compensation pattern for a lack of pure ankle dorsiflexion and usually what accommodates that with that is eversion and foot arch collapse.
• 4:57
  Speaker 1: So somebody could have a moderate arch that just collapses when they go into squats and running and walking and stuff.
• 5:05
  Speaker 1: That would be a stability issue.
• 5:07
  Speaker 1: So what's the course of action then to treat that?
• 5:11
  Speaker 1: Stability training, ankle stability and foot arch stability?
• 5:14
  Speaker 1: Part of that is the foot intrinsics, the plantar intrinsic muscles and some of the arch stability muscles the posterior tibialis is one of the main ones that influences the foot arch.
• 5:25
  Speaker 1: All right, the posterior tibialis is one of the main ones that influences the foot arch.
• 5:26
  Speaker 1: All right, the posterior tibialis is a muscle that comes off of the shin bone, the tibia.
• 5:32
  Speaker 1: All right, the back part, underneath your calf muscle, deep to the calf, sits the posterior tib, the posterior tibialis muscle, and it runs down the back of the shin towards the inside of the ankle and it inserts on the bottom of the shin towards the inside of the ankle and it inserts on the bottom of the foot underneath the arch.
• 5:47
  Speaker 1: And the navicular bone is a tarsal bone that has a big influence with that, all right.
• 5:52
  Speaker 1: So if we're checking out like navicular drop foot, longitudinal foot arch collapse, rolling into eversion and rolling into external rotation, that's a classic pronation sign of ankle foot pronation where stability plays a huge role with that.
• 6:07
  Speaker 1: But if they're lacking ankle mobility and a pure ankle dorsiflexion mobility and then foot ankle stability exercises to maintain a better foot ankle posture and position, with functional activity, things that then will progress and translate into running, sports agility, plyometrics, stuff like that, and, as they naturally are enabled to have maybe more of a foot arch, a stable foot arch and stable foot and ankle, it'll translate better to maintaining that, better stability with those functional activities like sports related stuff.
• 6:57
  Speaker 1: This is stuff we work on with people very often.
• 6:59
  Speaker 1: All right, conversely to that, all right, oh, one more thing about All right.
• 7:03
  Speaker 1: Conversely to that, all right, oh, one more thing about sorry.
• 7:05
  Speaker 1: What that also does is this is a common thing People will have anterior lateral ankle pain.
• 7:11
  Speaker 1: Anterior means forward, the front and lateral means the outside.
• 7:14
  Speaker 1: So the outside front part of the ankle will get injured, uh, impinged.
• 7:19
  Speaker 1: Impingement, we would call that lateral column compression syndrome.
• 7:23
  Speaker 1: All right, so the outside of the ankle and foot and ankle tarsal bones will get compressed and approximated in a butt into each other.
• 7:30
  Speaker 1: If somebody consistently rolls into E version under load with like squats and lunges and step ups and jumps and stuff like that and they're just slamming their arches collapsing, rolling into external rotation, and they're just slamming their arches collapsing, rolling into external rotation, rolling into eversion, the outside articulations, joints and the tarsal bones are getting approximated with force, right, they're getting abutted into consistently.
• 7:53
  Speaker 1: We would call that lateral column compression syndrome and that's ultimately a pure ankle dorsiflexion mobility problem and a foot and ankle stability arch problem.
• 8:03
  Speaker 1: That's what we can work.
• 8:04
  Speaker 1: So, with that being said, that could be problem.
• 8:06
  Speaker 1: We could solve that.
• 8:06
  Speaker 1: There's a course of action to work on those things and that's what we do.
• 8:13
  Speaker 1: We just have to figure out is that really your problem?
• 8:14
  Speaker 1: What is like the actual problem?
• 8:15
  Speaker 1: Where are you compensating and what things do we need to work on Right?
• 8:17
  Speaker 1: That's part of the investigation and evaluation process.
• 8:21
  Speaker 1: Conversely with that, let's say somebody has a very high arch and a stiff foot.
• 8:25
  Speaker 1: These feet are usually more stiff right.
• 8:28
  Speaker 1: They're stiffer, they're more rigid and they have a super high foot arch.
• 8:33
  Speaker 1: Pes cavus is what that would be called.
• 8:34
  Speaker 1: Pes planus.
• 8:35
  Speaker 1: Is arch collapse or a flat arch, a flat foot, pes cavus, super high arch, very stiff.
• 8:43
  Speaker 1: We would call that a supinated foot, whereas the other one would be a pronated foot.
• 8:48
  Speaker 1: This supinated foot has different compensation patterns still lacking.
• 8:54
  Speaker 1: Pure ankle dorsiflexion, all right, but a big component with this one too, I think a key is the big toe.
• 9:02
  Speaker 1: The big toe is more rigid as well and it doesn't bend backwards into extension, which would be like the same direction as dorsiflexion.
• 9:10
  Speaker 1: It doesn't bend backwards into extension as well.
• 9:12
  Speaker 1: It's more rigid.
• 9:13
  Speaker 1: So we can't neglect working on the big toe extension mobility the hallux is what it's called.
• 9:18
  Speaker 1: So hallux extension.
• 9:34
  Speaker 1: Mobility is a big issue.
• 9:35
  Speaker 1: With very stiff and rigid supinated feet, toe doesn't extend backwards well enough.
• 9:40
  Speaker 1: They're going to roll laterally and they're going to invert a little bit as they advance with the running gait pattern or walking gait.
• 9:49
  Speaker 1: As they advance into toe off and terminal stance of their gait pattern, they're going to roll laterally over their foot.
• 9:56
  Speaker 1: So that's a classic sign or indication and a thing that we find with super high arch, supinated feet and anterior impingement is very common symptom and big toe tightness is also a big common symptom.
• 10:12
  Speaker 1: And considering that, let's say you have an athlete that runs a lot and they have a high arch that's very stiff, lacking pure ankle dorsiflexion, bending backwards and their big toe, their hallux extension mobility is limited and poor as well and they're going to roll on the outside of their ankle and roll the outside of their foot and if they're a runner, they're putting undue consistent stress and load and pressure on the outside of their foot.
• 10:40
  Speaker 1: One of the most common sites for a stress fracture is the fifth metacarpal.
• 10:44
  Speaker 1: The fifth metacarpal will get it's not a big, heavy, thick bone, right, but it gets a lot of pressure and stress from the consistent pressure rolling into inversion or on the outside of your foot, the lateral part of the foot, with every step and every toe off and terminal stance of the running gait pattern, all right, so they're running on the outside of their foot.
• 11:05
  Speaker 1: It's an indication.
• 11:06
  Speaker 1: Check that out.
• 11:07
  Speaker 1: If you look at your shoes and where the sole is worn out and it shows kind of like within, where you're putting a lot of pressure and stress through your feet, is where the rubber on your shoes are getting worn out.
• 11:19
  Speaker 1: So it's just an indication to check it out.
• 11:21
  Speaker 1: Like oh like, the outside of my foot of my shoe is definitely worn out whereas the inside isn't.
• 11:26
  Speaker 1: Or the inside of my foot is worn out and the outside isn't, maybe pronated versus supinated.
• 11:31
  Speaker 1: It just indicates maybe some of the limited movement dysfunctions and impairments that are setting them up for failure at some point where it's going to start hurting.
• 11:41
  Speaker 1: And then they come see us and they're like that doesn't make any sense.
• 11:44
  Speaker 1: I've been an athlete my whole life.
• 11:45
  Speaker 1: All of a sudden now I didn't do anything different, but my foot's been killing me.
• 11:50
  Speaker 1: We have to investigate what is their problem and figure out the best course of action to treat it.
• 11:56
  Speaker 1: So once we have a better understanding of what's going on and why we can have a better treatment process and direction of how we can fix the problem right and ultimately that over enough time leads to success and improvements of symptoms and maybe even learning some new things, where their functional performance is going to be better than it was prior to the injury because they learned some stuff and were working on some things.
• 12:20
  Speaker 1: The other thing we can't neglect is there's a strong correlation with hip and glute strength and stability as it relates to ankle issues down the chain.
• 12:33
  Speaker 1: So again, like we wouldn't be doing our job if we didn't investigate upstream some other stuff that contributes to the kinetic chain down to the foot, with functional things like sports, agility, plyometrics, running, exercise, stuff like that.
• 12:50
  Speaker 1: And there seems to be a strong correlation with hip mobility issues or hip and glute strength stability issues that aren't stabilizing approximately Approximately means like up towards the center, up towards the attachment site, as best they could.
• 13:09
  Speaker 1: So the foot and ankle is going to compensate again.
• 13:12
  Speaker 1: So there's multiple things kind of contributing to the foot and ankle setting up for failure.
• 13:17
  Speaker 1: So wherever somebody has pain, the site of pain is usually the area that's overcompensating the most.
• 13:24
  Speaker 1: We would call that the more hypermobile area or the area that's just overcompensating the most.
• 13:30
  Speaker 1: All right, one of the two.
• 13:31
  Speaker 1: So, that being said, the painful site usually isn't the problem, it's usually the victim and we have to figure out why is it overcompensating and what are the things that aren't helping enough.
• 13:45
  Speaker 1: So we definitely need to fix the mobility impairments and dysfunctions and then also work on the joint strength, stability, muscle recruitment strategies that are setting up for failure and making something else the painful site chronically overcompensate.
• 14:04
  Speaker 1: So, with that lens, that's how we usually solve problems the best and get the long lasting results.
• 14:10
  Speaker 1: For people as in like yeah, I've been doing my exercise, I've been doing stuff and it hasn't hurt for a long, for many, many months, for a year I've been, I haven't ran so much as best as I have right.
• 14:19
  Speaker 1: That's amazing High five.
• 14:20
  Speaker 1: If we're able to actually solve the underlying root cause of the problem, we get better, longer lasting results.
• 14:26
  Speaker 1: And usually people that we see are motivated to like get better.
• 14:31
  Speaker 1: So that means they're going to be more um compliant with like doing these interventions on their own, versus just like one and done when they come see us and never do it again and they come see us again and that's it.
• 14:41
  Speaker 1: But usually people follow through when they come see us.
• 14:44
  Speaker 1: Um, so it's just interesting lens, Like if we apply that lens and that that's the diagnostic lens that we go through.
• 14:51
  Speaker 1: It's just more fulfilling for us because we get people better and then people are able to get back to their functional life.
• 15:00
  Speaker 1: You know.
• 15:02
  Speaker 1: So with the foot and ankle, that's a very common thing.
• 15:03
  Speaker 1: Oh, one more thing I wanted to say, so with I forgot to mention this pronated feet.
• 15:07
  Speaker 1: We mentioned the big toe with supinated feet, but with pronated feet we would call that subtalar hypermobile and they're more hypermobile, more loose, less stable midfoot, like their feet.
• 15:25
  Speaker 1: What is the big toes role in that?
• 15:28
  Speaker 1: Usually people walk in an externally rotated position and they push off of the medial part of their foot, whereas the supinated foot, they're rolling on the outside of their foot.
• 15:36
  Speaker 1: Well, pronated feet, they and the hypermobile foot, they roll on the inside of their foot, which consistently pushes the big toe in a lateral direction, and that's over a long period of time.
• 15:48
  Speaker 1: What's been found to suggest?
• 15:50
  Speaker 1: Suggested that that can increase the likelihood of risk of hallux valgus, which is the big toe, when it points outwards right and you get a bunion on the inside of the big toe towards the middle of the foot.
• 16:02
  Speaker 1: So like a medial hallux bunion from repetitive pronated foot postures and functional movement patterns through a pronated foot rolling on the inside of the foot and pushing off from the medial side of the big toe, chronically pushes the big toe, the hallux, in a lateral direction and that, over time, has been found to increase likelihood risk of hallux valgus and the bunion and that deformity I just forgot to mention that but in the correlation with the big toe, in contrast to the supinated foot.
• 16:36
  Speaker 1: So, anyway, that's stuff that we we'd like to educate people on and bring up, bring to light so that, um, they can buy in and they can like, they could like, dive in and be like.
• 16:47
  Speaker 1: I believe you, I trust you, let's do this together and I'm going to do everything you say, um, and the education department component is very important, um, and then, uh, with a clear, let's do this together and I'm going to do everything you say, an education component is very important, and then, with a clear diagnosis, we can make a better judgment call on what course of action do we take to actually solve the underlying root cause of the problem.
• 17:05
  Speaker 1: So, with all that being said, to solving these problems, unless there's a major structural issue, these problems.
• 17:17
  Speaker 1: Unless there's a major structural issue, I didn't mention surgery.
• 17:18
  Speaker 1: I don't do surgery, we don't do surgery.
• 17:19
  Speaker 1: But we've had great success with people where they maybe can avoid surgery.
• 17:22
  Speaker 1: That's amazing, right.
• 17:23
  Speaker 1: Would you want to avoid?
• 17:24
  Speaker 1: Do you want to have surgery?
• 17:26
  Speaker 1: I would hope people say no, right, but sometimes you need it.
• 17:30
  Speaker 1: I don't hate surgery and unless there's some kind of systemic issue or a severe structural abnormality that needs to be resolved structurally, then surgery isn't going to fix the problems we just described hip stability, recruitment, foot arch stability, recruitment, foot intrinsic strength, posterior tibialis activation strength, big toe extension, mobility and just dynamic hip, knee, ankle, foot stability as it relates to plyometrics and running and exercise and stuff.
• 18:05
  Speaker 1: Surgery isn't going to fix that.
• 18:07
  Speaker 1: It only fixes structural abnormalities.
• 18:09
  Speaker 1: It's just something to consider.
• 18:11
  Speaker 1: I don't hate surgery.
• 18:12
  Speaker 1: There's a time and place for it, for sure.
• 18:13
  Speaker 1: I'm just suggesting there might be a different path and please call us if you have any questions, because we can shed light on this stuff and maybe change a whole life trajectory for somebody that's been battling stuff like that.
• 18:25
  Speaker 1: So don't hesitate to reach out and I'm always open to questions, comments, concerns and conflicting opinions.
• 18:29
  Speaker 1: If you want to be a guest.
• 18:30
  Speaker 1: You know somebody might be a good guest.
• 18:31
  Speaker 1: Please reach out we.