Taking a Closer Look at the Ankle Joint: Dorsiflexion and Mobility

For over 20 years, I have been looking at my hips and back trying to figure out the pain and imbalance problems that I can't get rid of. My left lower back and my left front hip have always been the two areas that I can never seem to fix. I have been told not to run anymore by many doctors and even physical therapists have said it must be something wrong with my hip. But they are never sure what! I have actually helped my back, this past year, to feel the best that is has since the mid 1980s when triathlons just killed my back (or as I now suspect- a faulty bike set up and fit caused the problems).


I have always looked at my hip for a solution, but what if the hip is just the symptom and the problem can be found somewhere else. I have started looking somewhere else and I think I may be able to pinpoint the problem. Is there a solution? I don't' fully know, but if I could run marathons prior to my excursion into triathlons without the problems I have now, then why can't I get my body back to that point.

About a month ago, after much work with Feldenkrais, I started realizing that my hips and back seemed to work just fine (at least while lying on the ground). My left hip could do the same movements as my right hip. I then wondered if Feldenkrais would work on lower body parts, particularly my left foot and ankle. My left ankle does not work like my right ankle. The foot twists out to the side and the inside half of the foot is higher than the outside part. It is sort of like a twisted foot. If I point my left knee forward, the left foot points to the outside. If I straighten my left foot on the ground, my left knee knocks into the right knee. This has been a long-standing problem. In high school, I was jokingly given an award for being knock-kneed. When I started triathlons and fit myself to my bike, I knew my left foot pointed out, so I locked them into that position with my pedals. I did five intense years of triathlons (including five Ironman distance races) with this toed-out position on my left foot. After one year of triathlons, I was trying to figure out the pain in my back (I didn't do stretching or know anything about chiropractic back in those days 1983-1987). By 1987, I honestly thought I would be in a wheelchair by my mid-thirties as I couldn't do much of anything without trying to relieve the pain by cracking my back every 15 minutes all day long. I was a mess! I have improved a lot since then and have kept myself out of a wheelchair, but I have yet to fully straighten out my body again. I went to get physical therapy for the first time in 1988 right before my marriage, because I wasn’t sure that I could stand up long enough during the ceremony without needing to crack my back! This was less than one year after my fifth and final Ironman distance race.

Here I am back in 1985 winning a triathlon in Lakeville, Ma. The ankle-knee-hip thing isn't so bad. Same with this photo from  the Falmouth Road Race in 2004.

But look at what is happening at this year's Applefest 1/2 Marathon. It is painful to look at. I have to straighten things out starting somewhere.

So I started thinking again! What if the problem isn't my lower back (first problem area) or hips (a later problem)? What if it has to do with my feet. I have experimented with Morton's Foot remedies, but that doesn't fully address my misaligned foot. Could it be that my weird stride is because of my foot? When I run the left foot splays out to the side and then my foot rolls over the arch, sending my left knee in the opposite direction so that it knocks into my right knee. Then my femur sticks up into my hip socket at a weird angle causing the hip, butt, and back problems. My body has learned to compensate by getting all out of alignment and running with all sorts of twists and imbalances that somehow work (but is very ugly). I started wondering if I could fix my foot and ankle, thus creating a fix for my hip and back. I found a Feldenkrais ATM lesson for the ankles and used it the night before the Cape Cod Marathon in October. It was an hour-long practice with the ankle and I noticed something right off the bat, well I already knew this, but never really thought much about it. Part of the lesson was done lying on my belly. From this position, you have to leave your knees on the ground together and lift up your lower legs to a ninety-degree angle, bottoms of the feet pointed to the ceiling. With you feet together, you had to do slow movements: toes out-ankles together, toes together-heels out. I could move my right heel out, but the left would go nowhere. Doing these and other movements I was able after an hour to get my left heel to move less than an inch, but there was some improvement.

I have no idea if my left ankle-foot arrangement is something I was born with or something I developed through misuse or poor movement patterns (or locking myself into an unnatural pedal position). I decided to try to find out more information, and am still looking, and I am not sure it is something I can fully fix, but I am willing to see what I can do to improve my movement patterns. I am no expert, but unless my bones are formed improperly or worn down, (can that happen?) then it might be my muscles and ligaments that are holding things in bad positions and alignment and maybe that can be fixed. There are 26 bones, plus the tibia and fibula, in the lower leg, ankle, and foot so there are many places where "something" can go wrong.

In a well-written article called The Ankle Paradox: Building Indestructible Ankles for TMuscle.com, Jimmy Smith writes:

Some of my colleagues may want to slap me around a bit, but I'm convinced that the ankle is the primary cause of abnormal gait.... Pain or improper movement will cause the individual to compensate for the dysfunction.

I never have pain in that ankle, but I certainly have dysfunction and an "abnormal gait." So maybe the ankle is where I really should be looking and it looks like a very complicated joint complex. Here is a wonderful video of how the ankle joint complex works:



I still don't know how or if I can fix things. I do know this. Once I start running forward and put weight on my left foot rather than moving straight ahead over my foot, it feels "stuck" as my leg moves over my ankle (that part right in front of the angle-sort of like the vertex where the foot and leg meet).. Rather than move straight over the foot, the front of my ankle rolls to the inside, everting the foot out to the side, and rolling down towards the arch. Could this movement be throwing off my stride? Could this habit be the cause of my funky left foot positioning?

What if I could roll forward over my ankle in a straight line?There are many ankle mobilization videos that show how to test and work on this dorsiflexion. Bill Hartman shows how it is done in this video, as well as a tennis ball trick to work on the soleus muscle, calf muscle, and plantar muscles. I have been working on this mobility work to see if I can get a better sense of moving properly and gaining better dorsiflexion.




Here are other videos that take the ankle mobilizations further into a kneeling position. It helps you line up the knee and ankle with a long dowel or broomstick. The blurb for the first video states

Great warm up for walkers and runners, especially if you have suffered from a previous ankle sprain. Improves ankle and opposite hip flexibility, but more importantly helps to re-wire the front knee on how it is supposed to move and keep it from caving in during walking and running.

Here is another take on that mobilization:



I was also wondering a bit about something that chiropractor, Brian Bigelow, told me many years ago. He mentioned something about my tibia or fibula being out of position. I really didn't realize that these bones move in a small way as your ankle flexes. Bill Hartman shows a technique he developed to mobilize the ankle when the fibula is stuck in the forward position. I used a regular belt when I tried this and it seemed to do something the first time I did it. This stopped some of the pressure I was feeling in my left peroneals and knee. I used it again twice more in the following week when I had the same pressure. It seems to do something positive with my leg, so it is something I am trying to learn more about.



Bill Hartman together with Eric Cressey (I have a couple of his books, plus the Magnificent Mobility DVD), and Mike Robertson have recently come out with a new DVD called "Assess and Correct". I do not have this yet, but it looks very interesting. I am wondering if it gives any more information on ankle mobility techniques.

Here is an article with more videos called Alleviating Ailing Ankles by Carson Boddicker with many exercises to increase dorsiflexion. Carson writes:

All the issues can be both joint mobility restrictions and muscular tightness; achieving proper dorsiflexion should be addressed with a multifaceted approach including altering tissue lengths, joint mobility, and other modifiable lifestyle factors.

Here is a good blog post. It is for frisbee player, but they run too!
I am also looking again at the joint mobility work through the Z-Health exercises. I am paying proper attention to foot placements when doing them.

Many ankle mobility mobilizations require an expert to evaluate and practice. Here is an overview and then some other more complicated videos that I just want to keep track of.





Who knows if doing the simple mobilizations will improve my stride. I am willing to try. Like anything, I assume it will take some time to alter the tightness and alignment issues and then to let the body adjust.

My foot seems a bit better in alignment and as it straightens out. I notice more arch in my left foot. Mywhole foot seems to do its own wiggling and rotations that are not normal. I assume this is also a neurological problem and hope that if things fix in my foot, I can retrain the brain for proper movement patterns. Like everything else I try, I never know if it will work, but I think it is another step on the way to recovering my stride.

Yesterday was another warm and beautiful November day for running. I was stiff, particularly in the hamstrings, as I spent most of the week doing lots of additional things, Z-Health, resistance stretching, yoga, and a return to kettlebells. I think the kettlebell swings tightened up my hamstrings, but I wanted to get back to a consistent use of the kettlebells.

It took a few miles to warm up, but I ended up doing 11 miles and my stride was shifting after a while to a different position as I tried to keep the left foot straight. It really affects the rotations in both hips and the imbalances in my back. By the end of the run (which went very well), I was very stiff over my entire back. I will just take that as a sign that my balance is shifting and my body is readjusting. After a month, I can now rotate my left heel out about two inches when I do the Feldenkrais exercise I wrote about earlier.

The ankle joint is something I have to learn a whole lot more about. I would really like to know if it is possible to get that left foot to rotate back into position. If it is doable then I may really be onto something!