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Sliding surfaces of the ankle
  • Julie_G
    Yesterday I finally managed to loosen up the skin form the heel cord with some supernova ball whacking. But today I'm back to the way it was before. Am I missing something, or does sliding surfaces take more time to do lasting changes?

    - Julie
  • Kaitlin
    Yes, at first you may not have lasting results.
    You'll need to be consistent working with it especially in the beginning which is part of no days off with mobility.
    It didn't take a day to get the way it was so it will take more than one dose to undo it.
    Breaking any habit, making changes to technique, making changes to positioning or movement patterns is work.
    Keep working with it.
    Giving it a morning and afternoon dose will help. It won't always be this way.
    As you are working with it it will move to maintenance work that is needed.

  • Julie_G
    Thanks! That's what I thought. The ankle must be the hardest thing to make changes on, at least for me, and that's why I've decided to solely focus on the ankle (plus my really bad areas, hamstring and TFL). 

    Realizing I couldn't do ball whacking every day, I've come up with the following plan:
    1. Two times a day: Voodoo flossing (or ball whacking) for sliding surfaces, gliding of the fibular head, freeing up the calcaneus.
    2. Once a day: Soft tissue work, switching between working on the gastroc/soleus and the ant./pos. tibialis
    Does that look OK, or am I missing something? Banded distractions doesn't do anything for me yet (don't feel anything doing those), so I'm saving those for later on.

  • Kaitlin
    Yes, the ankle can take some time especially if the situation isn't new.
    Looks good.
    Spend time with techniques that you see changes with.
    Keep chipping away at it.
  • Julie_G
    A really late update!

    I got my skin sliding, I've worked on my soft tissue (pos/ant. tib, gastroc, soleus++) and I've worked on my joints (calcaneus, fibular head). I've even been to my manual therapist (she agreed that I lacked dorsiflexion), working on joints and muscles. Still no changes and I still got pinchy ankles.

    There is no hope is there? Might be a structural thing?  
  • Kaitlin
    Good to hear you are seeing some change and identified what needs attention.
    Episode 54: Pinchy Ankles and Weak Feet

    If its not a new situation it may take a little time to start seeing results keep chipping away at it.
  • Jesse FrederickJesse Frederick
    I've been working on my ankle for about 2 1/2 years. I'm getting really close to being fixed but I'm still not quite there. Depending on how long you've had the problem, an ankle problem can be more than an ankle problem. I'm almost 40 and it's possible my problems stem from a nasty sprain I had in 4th grade - exacerbated by every other sprain I had since then. I had almost no dorsiflexion in my right ankle. Doing the "knee to wall" test, I couldn't get my knee past my toes. My right hip was just as messed up with almost no range of motion. They only way I could walk was turning my foot out with a circumducting gait. If my left leg were as bad off as my right leg I would have been completely incapable of walking down stairs. Before I started fixing everything, doing the 10-minute squat test my right foot would turn out and I would fall backward just about the point where my thighs got to parallel with my feet hip width apart. Now I can almost get into the deep ass-to-heels squat with toes and heels touching. 

    I stil have something going on around the lateral malleolus. My talus is stuck in a forward/tilted up position and the fibula seems to use it as a fulcrum instead of gliding beside it. I believe the anterior talofibular ligament is tight. So, I googled "anterior talofibular ligament tightness" and found this interesting article. 


    I found this a couple weeks ago that also seems to apply to my case:


    Here is the interesting part:

    The heel will remain inverted in relaxed calcaneal
    stance, which may predispose to inversion sprain of the
    ankle and hyperkeratosis over the lateral border of the heel.
    In an attempt to stabilise the foot, the first ray plantarflex-
    es to make ground contact, giving the foot a high arch pro-
    file. Alternatively, hallux flexus progressing later into a
    hallux rigidus may develop. As a result of the lack of STJ
    pronation, the foot assumes a rigid posture with the MTJ
    remaining locked from the beginning of the stance phase of
    gait. This diminishes the shock absorbing function of the
    foot and problems affecting the knee, the hip and the lower
    back may arise. The lack of STJ pronation also causes an
    abductory twist to assist in the transfer of weight from the
    lateral to the medial side of the foot. This may cause
    hyperkeratosis over the medial     aspect of the hallux and may also cause a heloma durum
    over the plantar aspect of the fifth metatarsal head. 

    I had good success recently attacking the medial side of the lower leg. I can feel tension all the way from the calcaneous to the knee. Keep working on the ankle, but go after the hip joint also and go after the soft tissues of the upper and lower leg. Do some wide squats to open the hips and work on your splits. If, like me, your foot has been turned out for decades the soft tissues are going to be twisted around the tibia and femur. You can't fix that overnight. One last piece of advice, do yoga. Yogis have ways of stretching you out in ways would never dream of. Different instructors have their own things they like to do so go to a variety of classes led by different instructors. Even the right cue in Warrior 2 might cause a stretch in your back foot that will improve ankle function. 
  • Daniel Matrone
    So how are you addressing your ATFL?
  • Julie_G
    I'm going to try to sum everything up.


    Ankle injuries and anatomy:
    • Several mild sprains as a kid, playing handball doing gymnastics.
    • Growing pain in the ankles (but who haven't had that?)
    • Bunionett on the right foot
    • Bone spurs on the back of both heels (lateral to the heel cord)
    • Don't think I got rear foot varus.
    • I'm 99% sure I've always walked with feet straight, or almost straight.
    • When I walk I notice that as I put the front foot down and move into dorsiflexion, my knee goes in (valgus). It's either that or pain when knee goes over toes. Same with running.
    • As a kid I think my legs flared out as I ran fast (knee in, foot out)
    Mobility work I've done:
    • Banded and not banded ankle mobs, heel elevated, front foot elevated, weighted, kneeling, standing
    • Sliding surfaces with ball and voodoo floss
    • Calcaneus
    • Gliding of the lateral malleolus
    • Soft tissue work: gastroc, soleus, pos/ant tibialis, bottom of feet
    Observations:
    • Doing the basic ankle mob (mulligan) with band pulling the tibia back, the pinching at the front gets worse.
    • Band pulling tibia forward doesn't feel any different from without band.
    • Nothing eases the pain at the front.
    • My skin slides good now.
    • Sometimes I feel a stretch behind the lateral malleolus (not heel cord) in dorsiflexion, usually with straight or slightly bent leg.
    • My manual therapist did some joint manipulations and deep tissue massage of the soleus.
    • Been doing this for 3 months. 

    What I'm doing for my ATFL? No idea! Haven't gone into that much detail, but I've pretty much tried everything on MWOD.

    I'm not giving up, but I do need to prioritize. I'm starting boxing in january and I'm hoping to start BJJ/MMA/Thai Boxing/SW before 2016. I'm not getting any younger! :P

    Added a video in the link below, pretty clumsy one though, of feet from the back, and side into dorsiflexion. Maybe it won't show anything, but who knows? Video in comment below.

  • David ShenDavid Shen
    Julie I just watched the video. Just checking - when you bring the knee forward, is it heading slightly to the outside, maybe towards your 4th toe? if it's heading straight forward or towards the big toe, that encourages impingement.  

    in the video, you turn to the back but you didn't do the DF. thanks
  • Julie_G
    It's heading towards the 4th toe. New video below. I have no idea if this is even helpful, but if you see anything, let me know :)
    http://vid999.photobucket.com/albums/af117/Nessimelle/MOV_0515s_zps10794947.mp4
  • David ShenDavid Shen
    Ok good. some further thoughts:

    1. I would try the ankle DF movement with the foot/leg unweighted, like up on a chair or box.  If some of your weight is on the leading leg, that could cause you to reflexively tighten a little/lot to support your weight and balance.   try that - do you get more ROM when unweighted?

    2. have you tried distracting the ankle along the length of the leg? you anchor a band and wrap the other end around your ankle. lay down in the direction away from the pull of the band with the band pulling your leg away from the hip. you can use a low support like foam roller to rest your calf on.  this helps create space in your ankle bones.  do this on each side and then retest the ankle DF unweighted. do you have more ROM?

    3. i do not know what your manual therapist can do, but a good chiro/PT/sports med person will be able to release your ankles, similar to a chiro releasing your vertebrae.  if you find one to do that for you, test the ankle DF ROM before and after he does the release. is it better?

    4. do any of the above mobs mentioned in this thread work better than others? it can be very time limiting to work all around your leg.  test/retest after each one and focus on the ones that have the greatest effect.  do you have any tightness that is lingering/always there in your lower leg? that would give you a clue also.
  • Julie_G
    1) No, I don't get more ROM, only less pinching with leg bent.

    2) Have tried, no effect. I'll try again tomorrow just to make sure.

    3) She did release my ankles, but no effect on ROM.

    4) The changes are minor, but I'll focus on soleus smash, voodoo flossing and maybe a kneeling ankle mob.
  • Daniel Matrone
    Julie, 

    any partner smash stuff using their feet?  I use lacrosse balls, bone saw to do smashing, but it only really is effective after a partner smash using their feet.  
  • David ShenDavid Shen
    Julie, this one may be a good one to try:


    Roop did a lower leg rotate move on me also:


    I am wondering if some restriction in the lower leg and positioning of the bones may also be part of the problem. 
  • Julie_G
    David, the first one is almost identical to the mobilitywork I did with my manual therapist/PT (only pulling tibia forward not back, pulling tibia back makes the pinching worse).

    And I don't really have someone to do partner mobs with.

    I'll try out the last one.

    Distraction along the leg was just painful (the band was pressing on some tender areas at the front of the ankle and lateral malleolus)
  • David ShenDavid Shen
    Ok keep at it! It can take months to mob some areas properly. Be consistent and find time every day to work on it even if just a little bit.

    Also examine things that can hold you back like the way you walk or run and how you are placing your feet when you are doing either. Don't let the knees drift in to collapse the arch! Standing would be another one. Make sure you are creating an arch by gently externally rotating your legs when you stand.

    Good luck!
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