For every client we have that needs to stand and/or walk on their feet, we have some things that need to be checked. Hopefully that will be most of your clients, and if not thank you for working with those in special needs!
Our feet are easily one of the most under-appreciated areas of our body. We deprive them of tons of sensory information and natural movement because most people wear improper footwear and have never spent quality time getting to know their feet/ankles. So if you’ve never learned any ways of how to measure the quality of your clients’ foot/ankle movements then here is some great info to start using immediately. These three screens should take no longer than a five minutes to evaluate and can give you a ton of great information. We will review these top three screens and then give you some guidance on what to do with that information for corrective purposes and programming!
TOP 3 FOOT/ANKLE SCREENS
This allows us to qualify how much active eversion/inversion of the ankle your client possess. This is crucial because without proper eversion/inversion than dorsi/plantar flexion will always be impacted.
Have your client stand with feet together and hold onto an object to help with balance. Place one foot about a normal steps’ distance in front of you. Instruct the client to keep their knee still. It should not be allowed to sway from side to side. Have your client keep pressure through their heel and roll their big toe side of the foot up to the sky then back down. Then reverse the motion so the pinky toe side of the foot goes up then back down. Constant pressure should be kept on the heel so that movement is happening at the calcaneus/talus joint. Don’t be surprised if one of the motions is basically stuck or there is a lot of compensatory knee movement.
If your client is capable of the first step without compensation then instruct your client to slowly begin to put more and more weight on the heel of the front foot (lean forward over front foot) to test how much load is appropriate on the ankle during these movements. This is extremely important for runners, track athletes, gymnasts, and martial artists. These athletes are consistently exposed to movements that require ankle inversion/eversion and without proper loading/strength/control of these movements there is a much higher risk of injury.
Heel-to-toe Dorsiflexion Screen
This measures basic dorsiflexion and can give us a some information about the ankle in regards to dorsiflexion
Have your client stand holding onto an object for balance with their feet lined up heel-to-toe in such a way that they look like they are standing on a balance beam. We will be monitoring the back foot/ankle as this is the one going through the most dorsiflexion. Instruct your client to keep both feet flat on the ground and see how far they feel they can comfortably bend their knees/ankles. If the knee of the back foot can cross the medial malleolus (inner ankle bone) without the back heel leaving the ground without pain/discomfort then we can call that a “soft” pass. I say “soft” because the next step is to ask your client where they feel it. This is crucial because if your client passed the visual screen but feels a discomfort or pinch on the front of the ankle or somewhere in the hip then that ankle would not truly pass the test.
This is a screen for the general population and should have even greater standards for athletes that require heavy amounts of dorsiflexion such as runners, olympic weight-lifters, basketball, soccer, etc.
Your feet and toes should “hypothetically” have just as much dexterity as your hands/fingers. This screen allows us to see some of this potential.
Instruct your client to stand tall with their feet together. Keeping the ball of the foot down on the ground have your client begin to raise their toes as high as possible and then spread their toes as much as possible. If this is possible instruct your client to put their toes down one at a time as smoothly as possible and reset. Most clients will have difficulty with the spread and the smooth toe drop.
If your client can perform the basic test then progress for higher level athletes by instructing the client to raise just the big toe and keep the other four toes down. This must be done without any pronation of the feet (arches collapse). If this is successful then instruct your client to keep the big toes down and raise the other four toes.
For your consideration, I have ranked these three screens from highest priority to lowest priority already. That means that if you have a client who is greatly limited in all three of these screens then you should work on restoring ankle inversion/eversion first, plantar/dorsiflexion second, and toe dexterity third. This is not an absolute rule but is a great template for most clients. Any limited screens need to be further evaluated as to why there is limited motion. Does the client have passive range of motion? Is there any pain or discomfort with active/passive motion? Mobility issues can stem from structural, chemical, and neurological issues so it may require higher level therapy to fully clear the movement.
Regardless you now should have a great idea of which motions are most limited. While the client is performing an appropriate corrective strategy you can now more intelligently design training programs. It is not advised to load any dysfunctional movements. Really inspect the exercises you prescribe your clients. Ensure your clients are physically capable of what you’re asking them to do. For example, a client with a limited dorsiflexion screen may need to have certain squat or lunge movements modified until the ankle movement has been restored.
Regaining adequate mobility to your clients’ ankle/foot does not guarantee their squat will look perfect right away. It is still the job of any trainer/therapist/coach to get everything integrated together. This is why it is so critical for our clients to consistently be training specific joint mobility along with building the strength of fundamental movement patterns.