Ankle/Foot Injury & Biomechanics

Chiropractor, Dr. Alexander Jimenez appears at the way in which the foot and ankle combine — and explains how to avoid injury.

In sports, the ability to consume and transfer force through the foot and ankle complex is crucial for functionality and resilience against harm. The most obvious examples are in any running or jumping – based sport, but the capacity to push off the starting blocks and propel the wall off may be a significant determinant of sporting achievement when we consider swimming.

What about a non-weight posture game like water polo, however? Well, whilst it’s a legitimate point not much of the true match necessitates force absorption by the foot and ankle (except for holding your opponents at bay), then we need to consider all of the dry land training that these creature athletes will need to finish, including key lower body power lifts. So, as we can see, with the exclusion of stationary target sports such as archery and prone rifle shooting, we want our ankles in good nick.

Fundamental to all damage avoidance, operation and rehabilitation training programs is located a solid underpinning of an understanding of biomechanics and it’s that I want to follow in this report. Instead of the usual dry approach that appears at force vectors and trigonometry equations, however, what I will aim to pronounce here is on how we could use our understanding of biomechanics to drive our programming a useful focus.

It Is Complex

Whilst many Individuals often think of the As existing as the talocrual that is hinged joint ankle, the reality is that this is just part. It Includes the:

• Talocrual joint — between the talus and Both tibia and fibula;


• Subtalar joint — involving the talus and the calcaneus;


• Inferior tibiofibular joint — in the ‘southern’ end of the tibia and the fibula.

All three areas will need to work together to permit the foot to lift (dorsiflex), point (plantarflex) and rotate (supinate and pronate).

In a way like the wrist and hand working together to permit the fingers to operate well, the various midfoot joints will need to work in concert articulations to allow the foot to be positioned nicely for loading absorption and application. It is complicated in the name and nature!

Movement & Stability — Dual Masters

For your ankle to be able to work at its optimum level, it has to be a adaptor plus a lever. While both of these aims seem antagonistic, the effective co-ordination of these goals is to sporting achievement, essential. Let me clarify.

A stable and strong base is needed by the body to be able to apply force. In exactly the exact same manner we cannot fire a cannon we need to have the ability to retain stability to fulfill our motion wishes. How the ankle and foot complex achieve this is by:

• Keeping integrity between both the tibia and fibula through a structure known as the syndesmosis;


• Maintaining a “dynamic defense system” orchestrated from the nervous system by employed from the surrounding muscles to make sure that the ankle and foot aren’t “loose” upon earth impact;


• Maintaining a force bridge As the plantar fascia to permit power to be amplified and applied to the foot in a fashion reminiscent of a spring.

At the same time, but the foot requirements to be able to adapt to alterations in the platform upon which it interfaces. If we had been too stiff, we’d not have the capability to accommodate to these requirements and our purpose would be obviously compromised. Obvious examples of those demands are:

• Shifting terrain (like sand, loose Rocks or even landing from a jump on an opponent’s foot);


• Changing management when running;


• Manipulating foot posture to impart twist on a football when kicking.

As we could see, these demands can be quite… well, demanding! When this sport’s need is to execute the tasks in a split 18, this is amplified. Think about a goalkeeper in football who, after running out off the line to maintain a corner, lands on one leg on an opposition player’s foot, then has to change direction out of traffic and then kick the ball long into his teammate on the halfway line. This can take place at a second’s space, and in this moment, ankle and the foot have needed to execute biomechanical tasks, some proposed, some fanatical.

The Spring-Like Lever

We love the double functions of we could put our decision making regarding injury direction and injuries that impact these functions should make sense, the complex. For example, if we view a syndesmosis diastasis, an accident which affects the structural integrity of this inferior tibio-fibular joint, we all know that we will need to let it heal naturally to ensure that we have proper stability, or to manage it if conservative therapy is deemed unlikely to achieve this objective.

Alterations in the lively defense system, in which the ankle is not appropriately positioned to absorb floor contact, often from poor proprioception, leaves us vulnerable to ankle sprains and reduces our capacity.

Finally, any injury or dysfunction compromises the “Windlass effect” provided from the entrance of the Achilles tendon to the plantar fascia underneath the foot and onto the first metatarsophalangeal (big ft) joint, will reduce the capability of the spring to lever us into the propulsive phase of the next step.

We can see, therefore, that we will need to assess all of these areas to determine where the issue may lie, and know that frequently there’s an where dysfunctions in one, overlap domain can lead to dysfunctions in another.

The Mobile Adaptor

Many people’s idea of treatment is to receive the athlete to stand on a wobble board and that is it! I know so it’s no surprise this really is deemed satisfactory and that my education at university severely lacked in this sort of area. We know that the wobble board can be an effective tool in enhancing equilibrium that is dynamic but it cannot exist as the only intervention.

Let’s think about it. When you are standing on a wobble board, your ankle is at either a dorsiflexed or, at best, neutral position. Now, we know that the vast majority of ankle sprains happen when the ankle is at its loose-packed position (plantar-flexed). This is the neck of the talus is exposed to being pressured stretching the lateral ligament complex and because the restraints of the joints will be open. With this in mind it is logical to ensure our athlete is capable and confident before we send them back to battle?

It is with the role of the mobile adaptor in your mind I vary the surface which any retraining takes place on (beginning stable and then finally progressively to, quite literally, shifting sands), but also I change the position in which the ankle is made to function in, commencing in a close crowded place (weight bearing in dorsiflexion) to progressively more vulnerable positions (for instance, standing on tip toes).

Role Of The Calf Complex

It seems that everything in this region is known as ‘complex’ and this holds for the calf. This is due to the fact that the calf is comprised of the plantaris, both the soleus and the two heads of the gastrocnemius. From the texts, they act to plantarflex the foot and there is not any denying that this is a portion of the function. They have arguably a role, however, one that isn’t taught well at college, and that entails the notion of isometry.

We are taught that there are three Kinds of muscle contractions:

1. Concentric (shortening);

2. Eccentric (lengthening);

3. Isometric (holding).

In my head, the terms isometric and eccentric contraction are oxymorons, and we ought to rather refer to them as isometric and eccentric muscle actions. Whilst this may seem semantic and pedantic in nature, the truth is that an understanding of these activities are designed for is essential to our program design and delivery. This is especially the case once we consider the role of the complex from ankle and the foot.

There have been a number of studies examining the function which calf strength has in both functionality and predisposing us to, or resulting from an ankle sprain. Many are equivocal because most do not examine the nature of calf function, but that is.

As we run towards a complete sprint, we have to employ force with much less time in which to apply it because foot contact instances are reduced. If, as we were taught, our ankle consumed the floor contact and implemented pressure by a coupling of contractions, it would be impossible for us to move at pace. It would be too slow and far metabolically expensive. Take, for example, that the ‘burn’ when heel raises over a measure, you are feeling on your calves. This is a good instance of an concentric and eccentric muscle action coupling. When was the last time you believed this when running? Never!

The reason behind this is because the role of the calf muscle is to supply a foundation to permit the Achilles tendon to stretch and recoil. It does this by retaining behaving to hold without lengthening. We utilize the tendon to its entire extent. The tendon has the ability to recoil faster compared to muscle may and, because it’s non-contractile in character, it is metabolically efficient.

But with this in mind, and given that the calf complex attaches to the Achilles then onto the plantar fascia below the foot, when looking at developing the purpose of this spring-like lever we ought to do what we can to prepare the isometry of this calf.

How do we do this? There’s nothing wrong with doing great old-fashioned heel raises to make sure that the calf has good capacity, but to instruct operate, we need to do plenty of plyometric training. Not only can this train calf function’s nature in locomotion, but it may be improved during the rehabilitation period to make sure landing competencies are improved.

It’s because of this that I love skipping as a rehabilitation drill and a core competency that I want out of my athletes is to be able to perform 50 ‘double unders’ . At which the rope travels around two for each one jump A double beneath is. There is undoubtedly a skill component here and it takes some time to develop it, but out of an ankle perspective, if you can’t retain calf isometry along with the heel slows down via a slow rhythmic stage, what ends up happening is that the rope hits the shin on the next trip around. Because there’s just no way to deceive 13, the rope is loved by me. It can be a frustrating encounter throughout the learning phase but for the athlete, the skill acquisition curve is intense.