Ankle dorsiflexion is when you flex the foot and toes up towards your shin. Dorsiflexion is more limited than plantarflexion of the ankle, which is the opposite motion. The normal ROM for ankle dorsiflexion is 0-20 degrees
Primary muscles include:
Tibialis anterior- nerve supply is deep fibular nerve L5- S1
Extensor digitorum longus- nerve supply is deep fibular L5- S1
Secondary muscles include:
Fibularis tertius- nerve supply is deep fibular L5- S1
Extensor hallicus longus- nerve supply is deep fibular L5- S1
Limitations for dorsiflexion:
Tight plantarflexors such as gastroc, soleus, tibialis posterior, flexor digitorum, and flexor hallucis can limit dorsiflexion.
Weak dorsiflexors (tibialis anterior, extensor digitorum longus, extensor hallicus longus, and fibularis tertius can also cause limited dorsiflexors.
Stand close to a wall in a tandem stance facing the wall, have the back leg (affected leg) straightened, and lean forward against the wall and let the back leg stay stationary and feel a stretch in the posterior lower leg. The gastrocnemius is getting stretched here. Hold this stretch for 30 seconds and do 3 sets of this multiple times a day.
Do the same set up against the wall with the tandem stance, this time have the back leg (affected leg) bent at the knee, and lean forward against the wall and let the knee stay bent and don’t let it change positions. This stretch is getting a deeper structure in the posterior lower leg called the soleus. Hold this stretch for 30 seconds and do 3 sets of this multiple times a day.
Also, another stretch to perform is while long sitting, use a towel and wrap it around the foot of the affected side and pull the towel towards your body in order to pull the foot and toes towards the shin. Hold this stretch for 30 seconds and do 3 sets of this multiple times a day.
Indications for stretching:
Reasons to stretch the calf is when a physical therapist can’t passively dorsiflex the foot due to tight structures on the posterior side of the lower leg (calf) such as the gastroc and the soleus.
Contraindications for stretching:
Reasons to not stretch the calf would be if the patient has an acute Achilles tear or a gastroc or soleus tear.
To start, have ankle dangling off of table as you sit. Actively raise just the foot and the toes up to your shins. To make this harder you could add ankle weights on top of forefoot. Also, perform the movement in different planes of motion to progress. Perform this exercise for 3 sets of 10
Have a theraband on a stable surface to where it is stationary on one end (attached to stable surface or held by physical therapist) place the band on top of the midfoot and make sure the band is taut and then actively raise the foot and toes to your shins against that resistance. To progress and make this harder you could increase strength of theraband. Also, you could go in different planes of motion with dorsiflexion. Perform this exercise for 3 sets of 10.
Also, balancing exercises can help with dorsiflexion strengthening. Exercises such as doing single leg stance on the affected leg can help with proprioception, coordination, and strength of the dorsiflexors. Ways to progresss this exercise include single leg stance with eyes open, single leg with eyes closed, single leg on foam with eyes open, single leg on foam with eyes closed, single leg on foam while performing other tasks like catching and throwing ball. Make patient stand on single leg for 30 seconds and do 3 sets of this.
Potential Clinical Syndromes or Etiologies:
One syndrome that could present a patient with weak dorsiflexion would be a syndrome called drop foot syndrome. This can result from many complications such as a peripheral nerve deficiency or even diabetes. What happens in these cases is that the deep fibular nerve is affected and does not supply the dorsiflexion muscles of the foot. This causes weak dorsiflexion and can cause deviations such as gait problems when trying to clear the foot when stepping forward.