Dorsiflexion Test: Understanding Ankle Mobility, Causes of Limitation, and Improvement Strategies

What is dorsiflexion test?

The dorsiflexion test is a common assessment used to evaluate the range of motion in the ankle joint, specifically the ability to move the foot upwards towards the shin. It is crucial for identifying limitations that can impact athletic performance, daily activities, and increase injury risk.

Understanding Ankle Dorsiflexion

Ankle dorsiflexion refers to the movement that decreases the angle between the foot and the leg, bringing the toes closer to the shin. This motion primarily occurs at the talocrural joint, formed by the tibia, fibula, and talus bones. Optimal dorsiflexion is critical for a wide range of movements, including walking, running, squatting, jumping, and landing.

Why Perform a Dorsiflexion Test?

Testing ankle dorsiflexion provides valuable insights into an individual's biomechanical capabilities and potential limitations. Key reasons to perform this test include:

• Identifying Range of Motion Limitations: Detecting restricted ankle mobility, which can be a primary cause of compensatory movements elsewhere in the kinetic chain.
• Injury Risk Assessment: Poor dorsiflexion can increase the risk of injuries such as Achilles tendinopathy, patellar tendinopathy, anterior knee pain, ankle sprains, and even lower back pain due to altered movement patterns.
• Performance Optimization: Adequate dorsiflexion is essential for efficient movement mechanics in many exercises and sports. For instance, limited ankle dorsiflexion can hinder depth in squats, compromise landing mechanics, and reduce power output in jumping.
• Monitoring Progress: Tracking changes in ankle mobility over time, whether in response to rehabilitation, training interventions, or as part of a general fitness assessment.
• Identifying Asymmetries: Highlighting differences in mobility between the left and right ankles, which can contribute to imbalances and unilateral issues.

Common Dorsiflexion Tests

While several methods exist, the Weight-Bearing Lunge Test (or Knee-to-Wall Test) is the most widely used and practical, as it assesses functional dorsiflexion under load.

Weight-Bearing Lunge Test (Knee-to-Wall Test)

This test measures the maximum distance the knee can travel forward over the foot while maintaining the heel on the ground.

• Purpose: To assess functional ankle dorsiflexion range of motion, often revealing limitations caused by joint stiffness or calf muscle tightness.
• Procedure:
  1. Preparation: Stand barefoot facing a wall. Place one foot forward with the toes touching the wall.
  2. Execution: Keeping the heel of the front foot firmly on the ground, slowly lunge forward, driving your knee towards the wall.
  3. Endpoint: Stop when your knee touches the wall without your heel lifting off the ground.
  4. Measurement: Mark the position of your great toe on the ground. Slowly move your foot backward, away from the wall, until your knee can just touch the wall while your heel remains flat. Measure the distance from the tip of your great toe to the wall.
  5. Repetition: Repeat the test 2-3 times for each leg and record the best measurement.
• Interpretation: The measured distance (in centimeters or inches) correlates to the ankle dorsiflexion angle. A greater distance indicates better dorsiflexion.

Non-Weight-Bearing Dorsiflexion Tests

These tests are typically performed supine (lying on back) or prone (lying on stomach) and are often used in clinical settings to isolate joint mobility from soft tissue extensibility. While less functional for general fitness assessment, they can help differentiate the cause of limitation.

Interpreting Your Results

General guidelines for the Weight-Bearing Lunge Test:

• Normal Range: A measurement of 10-12 cm (approximately 4-5 inches) or more is generally considered adequate for most activities and helps facilitate proper squat mechanics and gait.
• Limited Dorsiflexion: Measurements below 10 cm often indicate restricted ankle mobility. This can lead to compensatory movements, such as excessive pronation of the foot, knee valgus (knees caving in), or rounding of the lower back during squats.
• Significant Limitation: Distances below 5-7 cm may be a significant barrier to effective movement and strongly suggest a need for targeted mobility work or professional evaluation.
• Asymmetry: A difference of 2 cm or more between the left and right ankle is considered significant and warrants attention, as it can contribute to unilateral pain or compensatory patterns.

Causes of Limited Dorsiflexion

Restricted ankle dorsiflexion can stem from various factors:

• Soft Tissue Tightness:
  • Gastrocnemius: The larger, superficial calf muscle. Because it crosses both the knee and ankle, its tightness is more pronounced when the knee is extended.
  • Soleus: The deeper calf muscle. Its tightness is more apparent when the knee is flexed.
  • Achilles Tendon: Shortening or stiffness of the Achilles tendon.
• Joint Restriction:
  • Talocrural Joint Capsule Stiffness: Tightness in the connective tissue surrounding the ankle joint.
  • Anterior Ankle Impingement: Bony spurs or soft tissue impingement at the front of the ankle joint, blocking full dorsiflexion.
  • Previous Injury: Scar tissue from ankle sprains or fractures can limit mobility.
• Foot Structure: Some individuals may have unique bone structures that inherently limit dorsiflexion.

Improving Ankle Dorsiflexion

Addressing limited dorsiflexion typically involves a multi-faceted approach:

• Calf Stretches: Regular stretching of both the gastrocnemius (knee straight) and soleus (knee bent) muscles.
• Ankle Mobility Drills:
  • Banded Dorsiflexion Mobilizations: Using a resistance band to pull the talus posteriorly (backward) while performing dorsiflexion, helping to improve joint glide.
  • Ankle Circles and CARs (Controlled Articular Rotations): Moving the ankle through its full range of motion in a controlled manner.
• Soft Tissue Release: Using a foam roller, massage ball, or manual therapy to release tension in the calf muscles and Achilles tendon.
• Strengthening Antagonists: Strengthening the tibialis anterior muscle (on the front of the shin) can help improve active dorsiflexion.
• Proper Footwear: Wearing shoes that don't restrict ankle movement or have an excessive heel drop.
• Progressive Loading: Gradually increasing the demands on the ankle through exercises like deep squats, ensuring controlled movement.

When to Seek Professional Advice

While self-assessment and general mobility exercises are beneficial, it's advisable to consult with a physical therapist, kinesiologist, or other qualified healthcare professional if you experience:

• Persistent pain during dorsiflexion or related activities.
• Significant asymmetry that doesn't improve with self-mobilization.
• A history of ankle injuries contributing to the limitation.
• Concerns about a bony block or impingement.
• Difficulty performing daily activities or exercises due to ankle stiffness.

A professional can provide a precise diagnosis, identify the specific cause of your limitation, and prescribe a targeted, evidence-based intervention plan.