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Our feet are our body’s connection to the ground, our foundation. They are the platform from which our entire body moves in every activity we do! So, naturally, having good foot and ankle mobility is imperative to maintaining an active and healthy life as well as independence in senior citizens. Foot and ankle mobility are essential for activities like walking, driving, going up and down stairs, and squatting. And not only is mobility at the foot and ankle important for everyday movement, but it can also help reduce risk of injury.
In this blog, we are going to discuss the importance of ankle mobility and describe some exercises that can help maintain good mobility and health of the foot and ankle in an aging population.
What is Ankle Mobility?
Ankle mobility is the ability of the ankle to move freely. Ankle mobility includes four different motions – dorsiflexion, plantar flexion, inversion, and eversion. The two motions that we use the most daily are dorsiflexion and plantar flexion. Dorsiflexion is the motion of bringing your toes up towards your shins. And plantar flexion is the motion of pointing your toes down, as if you were stepping on the gas pedal.
The Importance of Ankle Mobility in Seniors
Having good foot and ankle mobility helps with:
Better Movement
Having a foot and ankle that moves like it’s supposed to allows us to move better and more efficiently. Good ankle mobility allows us to live our lives like normal. It is important for activities we do every day, like walking, driving, going up and down stairs, and squatting.
Reduced Risk of Injury
A lack of ankle mobility can affect our body’s ability to absorb impact which then has to be absorbed somewhere further up the chain, usually at our knees, hip, or even our low back.
Ankle and/or foot stiffness can also increase the load and strain on other soft tissue structures, increasing the likelihood for soft tissue injuries.
Reduced Risk of Falls
Having a stiff ankle increases the likelihood of tripping – usually by catching your toe on something. This is usually from a lack of dorsiflexion mobility.
A stiff ankle is also less able to adapt to uneven surfaces whereas a mobile ankle is able to accommodate uneven terrain, reducing the risk of falls.
In a recent systematic review, researchers found that multiple studies have found an association between a loss of ankle mobility in seniors and an increased risk of falls. The good news is that the review also noted that there is evidence to support that participating in exercises to improve ankle mobility has a positive impact on balance and stability.¹
For more information on balance problems and preventing falls in senior citizens, please see our blog post: Preventing Falls and Empowering Lives: The Role of Balance Training for Seniors
Causes of Ankle Stiffness in Seniors
Over the course of a lifetime, our feet undergo a massive amount of load and stress that can cause age-related changes in the joints and soft tissue structures. Ankle stiffness can be caused by two factors – a joint restriction or a soft tissue restriction. A joint restriction is a loss of space between the bones that connect at the ankle. Essentially, the bones that make up the joint stop moving correctly. Soft tissue restrictions at the ankle joint include muscles, tendons, ligaments, and fascia. These structures can become stiff and inflexible over time as we age.
Ankle stiffness in seniors can happen for a variety of reasons:
Disuse
As we age, we tend to move less. And by moving less, our joints and muscles stiffen up and lose flexibility. Remember, “If you don’t use it, you lose it.” The body doesn’t want to waste precious energy to maintain the mobility and strength to do motions we don’t use frequently.
Movement helps keep our joints lubricated so that they can move easily. Movement increased the production of synovial fluid within the joint, which is the slippery stuff that allows our joints to move freely. Remember, “Motion is lotion!”
Old Injuries
Old injuries can stay with us, unfortunately, long after the injury is supposedly healed. If an old injury was never properly treated, your body may have lost some of its mobility or strength. Injuries can affect the flexibility of the joints, ligaments, tendons, or muscles, which can affect the available motion at a joint. Our bodies are amazing at adapting but there are times where your body just learns to compensate for old injuries, so these issues remain unaddressed and can rear their ugly head later.
The Beyond PT Difference
At Beyond Physical Therapy, we are experts in managing injuries! Our goal is to bridge the gap between medical recovery and fitness in the Tulsa Midtown and South areas. We offer a seamless transition from being a patient to independence in the gym.
We get it. You just spent all that time working to get rid of your pain – the last thing you want to do is risk hurting yourself again. But you still want to get back to your life. You want to be healthier.
Our team of physical therapists is ready to help you maximize your recovery after an injury! Our services and practices are designed to help individuals recover from past injuries and prevent any future issues caused by incorrect forms, stretches, or exercises. If you are recovering from an injury or have certain health conditions that you are concerned about when it comes to starting a new workout program, we would love the opportunity to help you! Please contact us here.
Footwear
While modern shoe wear provides protection for our feet, they may make things a bit too easy for us. While those soft, comfy soles may make you feel like you’re walking on clouds, that super thick sole puts our foot and ankle in a constant position of plantar flexion, causing stiffness and inflexibility in other soft tissue structures like the plantar fascia, calf muscle, and/or Achilles tendon. This is even worse in people that wear high heels regularly. Sorry to tell you, those cute kitten heels are probably doing more harm than good.
Modern shoewear also makes it so that our feet no longer need to adapt to uneven surfaces. Our feet are meant to conform to the surfaces we walk on. The flat shoe bottom and thick sole of most modern shoes minimize the bumps and divots that our foot would otherwise need to navigate. While this makes things easier on our foot and ankle, over time we may to lose strength in the muscles that support our foot and arch and ultimately, help with our balance.
Today’s shoe tends to have a narrow toe box. The toes should actually be the widest part of the foot. But take a look at most modern shoes and you’ll notice that the ball of the foot is often the widest part of the shoe and the tip of the shoe is pointed. This design stems from fashion statements from a long time ago when people of higher status wore pointy shoes. The pointy shoe fashion statement has never gone out of style!
The narrow toe box on most shoes today compresses our toes together and can impede the way the muscles on the bottom of our foot support our body, possibly limit blood supply to the foot,² and may lead to other conditions, such as bunions or plantar fasciitis.³ The importance of anatomically correct shoewear needs to be considered when thinking about overall ankle and foot health.⁴
Injuries Caused by Poor Ankle Mobility
Insufficient ankle mobility can lead to compensatory movement patterns at the joints above – usually the knees and hips but may also travel up as high as the low back. Poor ankle mobility could possibly contribute to the following injuries:
- Plantar fasciitis
- Bunions
- Achilles tendinitis
- Shin splints
- Patellofemoral pain syndrome (pain in and around the knee cap)
- Patellar tendinitis
- IT band syndrome
- Low back pain
Ankle Mobility Exercises for Seniors
Here we will discuss a few exercises that can be done to improve foot and ankle mobility in seniors:
Ankle ABC’s
Imagine that your foot is a pen or a pencil. Draw the alphabet with your foot. Try to draw capital letters and draw them as big as possible to maximize the movement required. This exercise is great for working all the different directions your ankle moves.
Calf Stretch
This exercise focuses on stretching out the soft tissue structures of the calf muscle. It can be performed in two stages. The level 2 variation is a progression from the level 1 variation.
Level 1 – Calf Stretch on Ground
Put your hands against a wall or on a counter for support. Reach one leg back behind you, trying to sink your heel down to the ground. Keep your knee straight. You should feel a stretch in the calf of the back leg. Make sure the toes on your back leg are pointing straight forward to maximize the stretch (most people tend to point their toes out). If you don’t feel a stretch, try reaching the foot back even further or lean forward a bit for an even better stretch, just make sure your heel stays on the ground.
Level 2 – Calf Stretch on Step
Start by standing on a step with one heel off the edge. Next, lower that heel towards the floor until a gentle stretch is felt along the back of your lower leg. Try to keep your knee straight. Be sure to use a railing for support.
If you cannot perform this version with good form and technique, or if it causes pain, please return to the level 1 version.
Ankle Dorsiflexion Stretch on Stairs
This exercise will help maintain ankle dorsiflexion mobility and your ankle. Limited ankle dorsiflexion can cause a limp and can even increase your risk of falling by catching your toe on something.
Stand at the bottom of a staircase. Lift one foot up onto the second step. Push your top knee as far forward over your toes as you can to stretch out your ankle. Try to keep your heel on the ground. To increase the stretch, you could try doing the exercise to the third step, just be sure to use a railing for support if needed.
Toe Extension Stretch
This exercise will help maintain toe extension mobility, which is necessary for push-off for walking and going up the stairs.
Sit at the edge of a chair with your feet flat on the ground. Lift up onto the ball of your foot, trying to lift your heels up off the ground as high as you can. Hold for 30 seconds. Return your heels to the ground.
Conclusion
- Good foot and ankle mobility are required for us to move normally.
- In the pursuit of overall health, longevity, and independence in the elderly, the importance of foot and ankle mobility should not be overlooked.
- Maintaining good foot and ankle mobility in the elderly may help reduce the risk of injuries and risk of falling in senior citizens.
References:
- Neville, C., Nguyen, H., Ross, K., Wingood, M., Peterson, E. W., Dewitt, J. E., Moore, J., King, M. J., Atanelov, L., White, J., & Najafi, B. (2020). Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis. Journal of the American Podiatric Medical Association, 110(5), Article_4. https://doi.org/10.7547/19-143
- Jacobs, J. L., Ridge, S. T., Bruening, D. A., Brewerton, K. A., Gifford, J. R., Hoopes, D. M., & Johnson, A. W. (2019). Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes. Journal of foot and ankle research, 12, 50. https://doi.org/10.1186/s13047-019-0361-y
- Hassan, Md & Biswas, Sudipta & Jor, Abu & Arefin, Md. Samsul. (2020). Investigation of Shoe Size and Toe Box Shape Variation Effect on Skeletal Alignment of Adult Foot.
- Beuscher T. L. (2022). The Importance of Shoe Selection: Clinical Practice Alert. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 49(1), 87–88. https://doi.org/10.1097/WON.0000000000000838