Last week we discussed a general strategy for increasing ROM at a joint. I thought since we used hip extension as our example in that post I would go to the foot and ankle next. I just want to show how the same simple strategies can apply in a joint very different to the hip.
Strategies for Increasing ROM
In the previous article we discussed 3 steps in this strategy:
- Choosing you planes
- Driving the Motion
Click here to read the full article: Increasing ROM
The most common motions you are going to want to get at the foot and ankle are:
- Rear foot eversion
- Rear foot inversion
- (Mid tarsal joint motions might have to wait for another day to avoid 3000 word post!)
Foot and Ankle Dorsiflexion
Positioning the Foot and Ankle
To position the foot and ankle in dorsiflexion is fairly straightforward. My go to starter strategy is to position in a traditional calf stretch position. You want them close to, but not at end range. If you jam right into end range you leave no room to create motion.
Choosing Your planes
In contrast to the hip, I’m not too worried about going straight after the sagittal plane motion. So you can choose from any of the 3 planes depending on the patient and their injury.
Driving the Motion
The easiest way to drive motion from here is using the knee that is in the air. That’s the left knee in the picture above. For sagittal motion drive the knee straight towards the wall. For frontal alternate between driving forwards and left and forwards and right. Here you will get both frontal and sagittal motion (and transverse if we are being picky!). You can tweak the amount of motion in each plane by how much forwards relative to sideways motion you drive. Finally, for transverse motion simply swing the left knee left and right, driving the pelvis through rotation, creating a really nice transverse plane motion at the foot and ankle.
Rear Foot Eversion/Inversion
To be honest, the above strategy will work for all motions of the foot and ankle. However, to explore this concept of increasing ROM I want to show a few variations.
The easiest way to position in eversion/inversion at the rear foot is using a wedge. I used to have a stretch cage and the base of that was sloping. It was genius and really helped drive motion in stubborn feet.
If it’s a right foot you position the wedge sloping for to the left for eversion and down to the right for inversion.
Choosing your planes
The likely aim of you going after these motions will be to increase their ROM/availability in function. In function these motions will most likely be combined with dorsiflexion, so sagittal drivers are great. However, transverse drivers would be a close second!
Driving the Motion
Most likely I would choose the same drivers as above, using the opposite side knee. However, if stability is an issue on the slope using the same side (right) knee driver is less disruptive and works well.
This is only a quick outline, but gives you an idea how the strategies for increasing ROM can be applied to different joints.
In terms of sets and reps it’s up to you. As with anything you have to base it on the severity, irritability and nature of the injury. In my experience the foot and ankle can take a fair bit of working compared to many other joints, but you can still annoy them if you do too much!
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