Ankle dorsiflexion, the movement of the foot towards the shin, is one of the most clinically significant and commonly overlooked joint mobility deficits in adults. Adequate ankle dorsiflexion is required for walking, squatting, stair climbing, and running. When it is restricted, the body compensates in a predictable way: heel rise during squat movements, knee valgus collapse, hip internal rotation, and lumbar flexion compensation. This compensation chain means ankle restrictions contribute to knee, hip, and back pain in adults who may never have had an ankle injury.
Common Causes of Ankle Dorsiflexion Restriction
- Previous ankle sprains: joint capsule tightness and anterior talofibular ligament scarring following lateral ankle sprains frequently restrict dorsiflexion
- Gastrocnemius and soleus tightness: the two-joint gastrocnemius limits dorsiflexion when the knee is extended; the soleus limits it regardless of knee position
- Tibiotalar joint capsule tightness: the joint capsule itself becomes restricted, particularly following immobilisation
- Flat foot mechanics: overpronation changes the relative positioning of the talus in the ankle mortise, restricting dorsiflexion available in a functional foot position
Assessing the Restriction
A weight-bearing lunge test measures functional ankle dorsiflexion: the inability to touch the knee to the wall while keeping the heel flat and the foot 12 centimetres from the wall indicates clinically significant restriction. A comparison between knee-bent and knee-straight dorsiflexion distinguishes gastrocnemius from soleus tightness from joint capsule restriction.
The Interventions
- Weight-bearing dorsiflexion stretches to address the joint capsule restriction specifically
- Soleus stretching with knee bent to isolate the soleus from the gastrocnemius
- Ankle joint mobilisation by a physiotherapist for persistent joint capsule restriction
- Strengthening the tibialis anterior to improve active dorsiflexion control