and/or injury. A lack of dorsiflexion refers to
the inability of the lower leg to come forward
over the foot and/or the foot to move toward
the shins (i.e. failure of the ankle to bend/
flex correctly). When the structures that
run across and on the outside of the foot
(e.g. lateral longitudinal and transverse
arches) are unable to do their jobs correctly
because of a lack of dorsiflexion, it can also
lead to foot pain (Bryant and Green, 2010;
Price and Bratcher, 2010).
Overpronation and a lack of dorsiflexion
are inherently linked because when the
foot/ankle are unable to bend/flex forward
effectively (dorsiflex) during weig ht bearing
activities, these structures collapse inward
toward the midline of the body (overpronate)
in order to displace the weight of the body.
Therefore, one of the easiest ways to
alleviate a client’s foot pain is to remedy
their overpronation issues by assessing
and improving their ability to dorsiflex
(Houglum, 2016).
1
2
Knee
extension
Knee
flexion
Dorsiflexion
Dorsiflexion
Figure 1. Dorsiflexion and bent knee
Figure 2. Dorsiflexion and straight knee
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Assessments for lack of
dorsiflexion
The ability of the ankle to bend/flex forward
(dorsiflex) so that weight can displace
evenly over the entire foot is necessary both
when the knee is bent, when squatting for
example, and straight, such as when walking
(see Figures 1 and 2).
As such, evaluating your client’s ability
to dorsiflex requires two assessments –
one with their knee bent and one with their
knee straight.
1. Bent knee assessment
To assess dorsiflexion when the knee
is bent, instruct your client to place
themselves in a split-kneeling position with
their hands on the wall in front of them for
balance (see Figure 3). Coach them to align
their hips so that they are parallel to the
wall and push their front knee forward so
it travels forward over that foot. Have them
perform this movement with each foot/leg
and evaluate which side is tighter, or feels
more difficult to bend their ankle forward
(dorsiflex). Watch that the client does not
‘cheat’ during this assessment by letting
their ankle and knee collapse inward toward
the midline (overpronating), and/or twisting
their hips (i.e. not keeping them parallel to
the wall) (Price and Bratcher, 2010; Cook,
2010). Make a note of any discrepancies
or imbalances you, or your client, discover
about their ability to dorsiflex with their
knee bent.
2. Straight knee assessment
To assess dorsiflexion when the knee is
Figure 3. Assessing dorsiflexion (with knee bent)
straight, instruct your client to stand in a
split-stance standing posture with their
hands on a wall in front of them for balance
(see Figure 4). Coach them to align their
hips so that they are parallel to the wall
and straighten both feet so that they are
pointing forward. Once in this position,
instruct them to ‘stretch’ the calf muscle
of the back leg by allowing their lower leg
to travel forward over the foot (dorsiflex).
Watch that the client does not raise their
heel off the floor, collapse their ankle
(overpronate) or rotate their hips during this
movement. Ask them to assess both sides
and evaluate which side feels more difficult
to dorsiflex (i.e. bend their ankle forward
without ‘cheating’ at their ankle or hips)
(Price and Bratcher, 2010). Make a note of
any discrepancies or imbalances you, or
your client, discover about their ability to
dorsiflex with their knee straight.
4
Figure 4. Assessing dorsiflexion (with knee straight)
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