As a runner, ensuring adequate foot and ankle mobility should be a priority
If any one of the biomechanical requirements of the foot and ankle is not fully functional, the human body will create a compensatory pattern to get the desired result of continued forward motion. Over time, compensatory patterns may lead to abnormal movement patterns and running related injuries, like IT Band Syndrome, shin splints, knee pain and/or plantar fasciitis to name a few. Runners, competitive and recreational alike, consistently show patterns of abnormal foot mobility. Although some runners may be talented (and lucky) enough to sustain compensatory patterns without getting injured, for most of us, this is not the case.
At the foot, pronation and supination are required for running without compensation. Contrary to popular belief, pronation is normal and needed for appropriate biomechanics to occur elsewhere up the leg and into the body! Shoes that lock the foot into supination are inappropriate for most runners as they may feel great initially, but they are a band aid that could likely cause a different area to breakdown over time.
During the initial loading phase of running (foot strike), the outside of the foot should hit the ground first. From here, the foot ‘unlocks’ and rolls into pronation - simply put, the arch collapses. Pronation allows for shock absorption and causes a chain reaction up the leg that creates optimal hip - especially glute - and core musculature utilization. Both limited pronation mobility as well as pronation control can lead to bunion formation, knee pain, and low back issues.
Following pronation, the foot supinates (arch lifts) and forms a rigid lever for the lower extremity to push from to take the next step. The better your foot supinates, the more successful your calf and glutes will be to help propel your body forward. Both limited supination mobility and supination control can lead to big toe pain, Achilles and calf strains, and anterior hip discomfort.
Ideally, the ankle should be close to neutral at foot strike, although exact positioning will depend on whether you have a heel, mid, or forefoot strike. The ankle then moves through a significant amount of dorsiflexion during the late stance phase of the running cycle. As the foot pushes off and enters the swing phase, the ankle moves into plantarflexion.
Every step taken while running requires a large range of ankle dorsiflexion and plantarflexion and insufficient mobility can lead to altered biomechanics and compensatory patterns. If ankle dorsiflexion is limited, it is difficult for the hamstrings and calves to effectively help absorb impact forces during the initial foot strike phase of running. Additionally, limited ankle dorsiflexion during the late stance phase will result in compensatory motion in the low back - specifically, in the form of hyperextension.
As you can see from this basic overview, there are many complexities in terms of how the foot and ankle move during the gait cycle. Too much or too little pronation, supination, and dorsiflexion can lead to a number of different injuries which is why obtaining ideal foot and ankle mobility is so important.
Developing foot and ankle mobility and stability takes work, but fortunately for our readers, we have created some exercises to help!
Below you will find a guide to improve the most important ankle and foot motions of the running cycle: pronation, supination, and dorsiflexion. For example, if you have a supinated foot (high arch) and your arch has trouble dropping, you should work on pronation exercises. Or if you have an ankle that lacks dorsiflexion, you should work on dorsiflexion exercises.
As a note - if you have trouble determining how much foot motion and/or stability you have, please reach out to your physical therapist to learn more about how your foot moves and what biomechanics, if any, need to be addressed.
Keep in mind that foot pronation is necessary to absorb shock and activate your glutes!
Gently roll your knee in and push down through your arch - you should not feel much with this drill. Your knee should be pain free too!
While doing a backwards rotational lunge, gently roll your front knee in and push down through your arch.
Remember, foot supination is crucial for effective forward propulsion during walking and running!
Rotate your back knee out and notice your arch lift - just make sure you keep your big toe down!
While keeping the foot closest to the box fully on the ground, rotate your opposite leg and step to the box. Make sure to keep your big toe down!
Your goal with this test is to keep your heel down, push your knee forward over your 2nd toe, and gently tap the wall with your knee. Keep sliding your foot backward from the wall until it is difficult to tap the wall without your heel lifting.
To have "normal" dorsiflexion, you should be able to fit your fist between the wall and your toes.
If ankle dorsiflexion is lacking, it is likely that you will compensate through your low back and knees during every step of walking and running.
In the video below, the focus is on your back leg. Keep your back heel down and push your back knee forward over your second toe (you could also perform this with your backside knee in a bent position). Once you feel a stretch in your calf and/or Achilles, use your backside knee and hips to pulse forward, side to side, and rotate as shown in the video.
Your goal for this exercise is to drive the knee and shin forward as you perform mini squats. In addition to driving the knee and shin straight forward, make sure to drive inward and outward as shown in the video.
Dr. Dan Benson, DPT, OCS, FAFS
Forefront Physical Therapy
Belltown & South Lake Union
2720 4th Ave #115
Seattle, WA 98121